27 Works

Predicting Bleeding and Thrombosis Complications in Patients with Continuous Flow Left Ventricular Assist Devices

Kyle Zacholski, William Kuan, Justin McCann, Aric Schadler, Aaron Cook, Sara Parli & Adam Sieg
Background Left ventricular assist device (LVAD) therapy has been proven to relieve heart failure symptoms and improve survival, but is not devoid of bleeding and/or thrombotic complications. Risk stratification tools have been utilized in other cardiovascular disease populations to estimate the risk of bleeding and thrombosis with and without anticoagulation, including the HAS-BLED, HEMORR2HAGES, CHADS2 and CHA2DS2-VASc models. The study objective was to evaluate the predictive value of available risk models for bleeding and thrombotic...

Unusual Case of Pump Thrombosis in LVAD Patient with COVID-19 — Diagnostic Challenges

William H. Frick, Ryan D. Mallory, Maya Guglin, Eve Anderson, Erin N. Lushin, Rey P. Vivo, Kashif Saleem & Roopa A. Rao
We present the first reported case of left ventricular assist device (LVAD) pump thrombosis in the setting of the coronavirus pandemic. We describe the clinical features of the case which helped to differentiate coronavirus disease 19 (COVID-19) from LVAD pump thrombosis. The patient is 56-year-old female supported by destination LVAD therapy. She was originally implanted with a HeartMate II device in 2015 and underwent two pump exchanges in 2017 and 2019 for pump thrombosis, despite...

Improved outcomes in the treatment of post-myocardial infarction ventricular septal defect with percutaneous TandemHeart® left ventricular mechanical circulatory support

Pranav Loyalka, Angelo Nascimbene, Sriram S. Nathan, Rajko Radovancevic, Ajay S. Raman, Manish Patel, Keshava Rajagopal, Biswajit Kar & Igor D. Gregoric
Background Post-myocardial infarction (MI) ventricular septal defect (VSD) is associated with 40% - 50% of peri-procedural mortalities; however, it is amenable to catheter-based therapies. We retrospectively investigated the impact of state-of-the-art bridging percutaneous left ventricular mechanical circulatory support (MCS) using the TandemHeart® (TH) ventricular assist device (VAD) on a patient with post-MI VSD. Results From July 2008 to March 2014, 23 patients were referred for treatment of post-MI VSD. Initially, 18/23 patients required MCS; 12...

Heart Rate Variability: A Possible Machine Learning Biomarker for Mechanical Circulatory Device Complications and Heart Recovery

Theodore Lin, Zain Khalpey & Shravan Aras
Cardiovascular disease continues to be the number one cause of death in the United States, with heart failure patients expected to increase to >8 million by 2030. Mechanical circulatory support (MCS) devices are now better able to manage acute and chronic heart failure refractory to medical therapy, both as bridge to transplant or as bridge to destination. Despite significant advances in MCS device design and surgical implantation technique, it remains difficult to predict response to...

Modeling Hospital-Wide Extracorporeal Cardiopulmonary Resuscitation: Pros and Cons

Shiksha Joshi, Sandipan Shringi, Manpreet Sira & Maya Guglin
Background We aimed to analyze the potential benefits of implementing a hospital-wide extracorporeal cardiopulmonary resuscitation (ECPR) protocol. Methods We analyzed in-hospital cardiac arrests in a large, academic hospital for two consecutive years. For this model, we assumed that ECPR would be started in all adults, with no upper age limit, who have a full code status. We excluded codes lasting <15 minutes, arrests with asystole as an initial rhythm, and patients with hemorrhagic shock or...

Angiotensin Inhibition and Gastrointestinal Bleeding Prevention in Patients with Left Ventricular Assist Devices

Phillip Weeks
Gastrointestinal bleeding remains a common complication in advanced heart failure patients following implantation of continuous-flow left ventricular assist devices. While the cause is likely multifactorial, development of arterial venous malformations in the gastrointestinal mucosa are a key factor. Inhibition of angiotensin II activity has been postulated to disrupt the signaling that promotes angiogenesis in these patients. We aim to review the theoretical basis for angiotensin receptor blockade, which has been proposed and explore the published...

Feasibility of the use of a Stereoscopic Camera In the Final Inclusion (SCI-FI) of Donor Organ Assessment Using Virtual Reality Technology

Ismael A. Salas de Armas, Juan Marcano, Jayeshkumar A. Patel, M. Hakan Akay, Manish K. Patel, Bindu Akkanti, Marwan Jumean, Sachin Kumar, Rajko Radovancevic, Sriram S. Nathan, Biswajit Kar & Igor D. Gregoric
Objective: Donor organ assessment is challenging, particularly when physicians and surgeons have to make decisions remotely. To improve communication and preparation for the transplant process, we proposed that a versatile, secure, and transportable video presence would enable a detailed assessment of donor organs. Methods: A virtual reality camera with a 360-degree visualization range was used with a smartphone receiver to enable integral assessment of the donor's heart in the operating room, with visualization of the...

Transcutaneous Energy Transmission: Can we do it now?

Yuriy Pya
The percutaneous driveline used in contemporary LVADs presents a continuous risk of infection for the duration of support. Minimizing infection in durable mechanical circulatory support systems requires total implantation of all components and energy transfer by means other than percutaneous drivelines. A novel coplanar energy transfer (CET) system, similar to the original transcutaneous energy transfer (TET) design, is unique by incorporating two large rings with coil-within-the-coil topology to ensure strong resonance power. The CET system...

Advantages of bridging to durable left ventricular assist device with the Impella 5.0

Manish K. Patel
The mainstay therapy for patients in critical cardiogenic shock (CS) is temporary mechanical circulatory support. Although there is a trend toward use of durable left ventricular assist devices (LVAD) in patients that are less ill, we present our experience with using the Impella 5.0 (Abiomed) to illustrate the potential benefits of supporting patients with critical CS before durable LVAD implantation. Since 2012, our use of the Impella has increased from 5 to 38 per year....

Occupational therapy’s role with ventricular assist devices and the promotion of travel protocols

Natasha Chandra & Linda Suplicki
An option for individuals diagnosed with end-stage heart failure is to receive a ventricular assist device (VAD). In 2006, Shepherd and Wilding produced an article regarding occupational therapy’s role during the VAD process as they anticipated a growing need for this area of practice. Since that time, there continues to be a lack of supporting literature on occupational therapy’s important role with this population. Therefore, the purpose of this article is to explain an occupational...

Cutting the Cord: A Case of Late Presenting Driveline Infection

Brian Laughey, Lauren Eyadiel & Barbara Pisani
Ventricular assist device (VAD) related infection, specifically driveline infection, is a common complication after VAD implantation. A 45-year old patient with a delayed skin infection at the site of the original driveline nearly one year after VAD inactivation and surgical driveline burial was treated with antibiotics and surgical debridement for approximately six months. Continued discharge at driveline site and growth of methicillin susceptible Staphylococcus aureus resulted in the recommendation of explantation of the VAD. Post-VAD...

Left Ventricular Assist Device Thrombosis Treated with Intravenous Tissue Plasminogen Activator in a Patient with COVID-19 Infection

Simone A Jarrett, Jafar Alzubi, Savalan Babapoor-Farrokhran, Zaid Ammari, Mohammad Al Sarie, Zachary Port, Farhan Hasni, Behnam Bozorgnia & Raphael Bonita
Left ventricular assist device (LVAD) implantation is an established treatment for patients with end-stage, systolic heart failure as a bridge to heart transplantation or destination therapy. LVAD pump thrombosis is a life-threatening complication than can be triggered by prothrombotic conditions such as infection. Management of pump thrombosis presents as both a diagnostic and therapeutic challenge that is associated with a high morbidity and mortality. We report a case of pump thrombosis in a patient with...

Guideline-Directed Heart Failure Therapy in Patients after Left Ventricular Assist Device Implantation: A Review

Bailey M. Colvin, James C. Coons & Craig J. Beavers
Background: Left ventricular assist devices (LVADs) are used as an advanced therapy option for patients with stage D heart failure. These devices provide mechanical unloading of the heart as either a bridge to transplant or recovery, or as destination therapy. In patients with LVADs, there are emerging data on the use of heart failure guideline-directed medical therapy (GDMT) to improve outcomes. This review describes the current evidence available for the use of neurohormonal blocking agents...

What Did We Learn about VADs in 2020?

Maya Guglin
This is our 7th annual literature review on mechanical circulatory support (MCS) devices. Our previous reports were well received by the readers. The full text of the reviews for 2014, 2015, 2016, 2017, 2018, 2019 1-6 were downloaded 807, 843, 638, 827, 841, and 199 times, respectively. In this review, we summarized the most interesting and important, from our standpoint, publications covering MCS from 2020. There may be some slight overlap with the end of...

Cangrelor: Safe and Effective for Left Ventricular Assist Device Thrombosis

Roopa Rao, Eve Anderson, Mark Jones, Muhamed Safiia & Maya Guglin
Pump thrombosis is a devastating complication of left ventricular assist device implantation as it increases the risk of mortality and morbidity. Early and effective treatment is important to prevent the progression of the clot and to avoid the surgical need for pump exchange or heart transplant. The current strategies of intensifying anticoagulation therapy are not consistently effective and carry significant bleeding risks. Cangrelor is a new pharmacological agent that has been utilized as an antiplatelet...

Successful pregnancy with centrifugal flow left ventricular assist device: A case report and review of the literature

Seyed Hamed Hosseini Dehkordi, Matthew R. Lippmann, Travis Abicht, Andrew J. Sauer, Nicholas A. Haglund, Marc R. Parrish Parrish, Jared Staab & Bhanu Gupta
Succesful deliveries from patients supported by axial flow left ventricular devices have been previously reported. We present the first case of a successful pregnancy and birth in a patient with a centrifugal-flow left ventricular assist device. A 24-year-old female with methamphetamine-induced cardiomyopathy and end-stage congestive heart failure supported by a HeartWare™ ventricular assist device (Medtronic) presented two years after device implantation with an unplanned pregnancy at 11-weeks of gestation. Following a multidisciplinary evaluation by experts...

Evaluation of Outpatient Anticoagulation Bridging After Left Ventricular Assist Device Implantation

Rebecca A. Rainess, Laren Alderman, Teresa Cicci, Monty Yoder, Barbara Pisani, Thomas O’Neill & Diego Malaver
Objective: The aim of this study is to evaluate the safety of outpatient anticoagulation bridging following left ventricular assist device (LVAD) implantation. Methods: This study is a retrospective, single-center cohort of adult patients who underwent LVAD implantation (HeartMate II™ or HeartMate 3™) and received warfarin and at least one dose of therapeutic enoxaparin or fondaparinux for outpatient anticoagulation bridging. The primary endpoint was the incidence of bleeding complications within one week of completing the bridging...

Should COVID Vaccination Be Required in Heart Transplantation & Left Ventricular Assist Device Implantation?

Mustafa M. Ahmed, Manjula Ananthram & Susan M. Joseph
No abstract available

Cardiac tamponade on ECPELLA: a case report of a unique hemodynamic picture

Naveed Akhtar, Parth Savsani, Maya Guglin & Roopa Rao
Extracorporeal membrane oxygenation is rapidly becoming a preferred therapy for short-term hemodynamic support in cardiogenic shock, along with the use of devices such as Impella (Abiomed, Andover, MA). The two together can create unique hemodynamics resulting in altered presentation of common hemodynamic conditions such as tamponade. We present a case of a patient with fulminant myocarditis requiring veno-arterial extracorporeal membrane oxygenation and Impella support. The patient later developed a pericardial effusion with atypical tamponade physiology,...

Off-pump HeartMate II Exchange in a Patient with Severe Lower Extremity Peripheral Artery Disease: A Case Report

Mehmet Akay, Ismael Salas De Armas, Manish K. Patel, Rajko Radovancevic & Igor D. Gregoric
Thrombosis of left ventricular assist device (LVAD) pumps is a serious complication that often requires exchange of the device. A 66-year-old man with severe peripheral vascular disease presented with pump thrombosis of the HeartMate II (HMII) LVAD 1.5 years after implantation. The HMII was exchanged to another HMII through a subcostal incision and without the use of cardiopulmonary bypass. For safety, the patient was prepared for cardiopulmonary bypass by exposing the right subclavian artery and...

A Case of HeartMate 3 Outflow Graft Twisting with Extraluminal Thrombosis: Is Computed Tomography Angiography Helpful?

Karim Saleb, Marianna Zagurovskaya, Michael Sekela & Maya Guglin
Twists in the outflow graft of the HeartMateTM 3 device (Abbott) have recently been described as a sporadic, late complication. We present a case with a unique combination of external compression of the HeartMate 3 outflow graft by a surgical scar compounded by thrombus formation in the space between the band relief and the outflow graft with associated twist of the outflow graft and severe flow limitation. Computed tomography angiogram (CTA) of the chest was...

Lactate Dehydrogenase Rising: Bleeding or Clotting?

Ashleigh Long, Amin Yehya & David A. Baran
Modern continuous-flow ventricular assist devices (VADs) have greatly improved the survival of patients with end stage heart failure. However, they are associated with adverse effects, including cerebrovascular accidents (CVA), bleeding, infection, and device thrombosis. Definitive measures to evaluate for pump thrombosis can be challenging; hence, multiple laboratory and imaging modalities have been studied to help guide decision making. Lactate dehydrogenase (LDH) has proven to be a reliable test when used in the appropriate clinical settings...

What is a VAD Social Worker? A National Perspective

Pamela Combs, Will Cohen, Umar Siddiqi & Valluvan Jeevanandam
Ventricular Assist Device Social Workers (VAD SWs) are mandated members of VAD care teams and contribute to the psychosocial aspect of patient care within the United States. However, the contributions and methods of the VAD SW are relatively undefined. This article reports the results of two national surveys regarding VAD SWs. One survey ascertains the VAD SW’s views of their work and their role in the VAD care team. The other survey assesses the VAD...

What Did We Learn about VADs in 2019?

Maya Guglin
This is our 6th annual literature review on mechanical circulatory support (MCS) devices. Our previous reports for 2014, 2015, 2016, 2017, 2018 were published as open access articles and were well received by the readers (1-5). In this paper, we summarize the most interesting and important, from our standpoint, publications from 2019. As we have done for the past two years, a section on extracorporeal membrane oxygenation (ECMO) is included and primarily addresses new developments...

A “Blinking” Left Ventricular Assist Device

Maya Guglin & Roopa Rao
Guglin M, Rao R. A ”Blinking” LVAD. The VAD Journal. 2020; 6(2):e2020627. https://doi.org/10.11589/vad/e2020627

Registration Year

  • 2021

Resource Types

  • Data Paper


  • Indiana University
  • University of Kentucky
  • Community Health Network
  • Saint Vincent Hospital
  • University of Chicago Medical Center
  • Wake Forest University
  • Northwest Hospital and Medical Center
  • University of Florida
  • The University of Texas Health Science Center at Houston
  • University of Arizona