Cardiology Commons^™

Ultrasound – An Underutilized Diagnostic Tool For Ventricular Assist Device Driveline Infections, Kristina Krzelj, Tomislav Tokic, Tomislav Kopjar, Maja Cikes, Davor Milicic, Hrvoje Gasparovic

The VAD Journal

Patients with ventricular assist device (VAD) driveline infections (DLI) have reduced quality of life and increased risk of severe complications, such as sepsis, hemorrhagic or ischemic stroke, and wound infections. The management of VAD patients imposes a significant financial burden due to prolonged in-hospital stays, frequent re-admissions, expensive diagnostics, and the need for antibiotic therapy and/or surgical intervention. There is considerable room for improvement in DLI management, particularly in the early detection and treatment stages. Ultrasound, an easily applicable device available in almost every hospital, offers an unrecognized potential for the early detection of DLI. By increasing awareness about the …

Pulsatility Is A Predictive Marker Of Improved Cardiac Function In Patients With Liquid Matrix-Treated Left Ventricular Assist Devices, Philemon Mikail, Rinku Skaria, Marvin Slepian, Janny Garcia, Richard Smith, Zain Khalpey

The VAD Journal

Objective: Left ventricular assist devices (LVADs) are utilized as a bridge to transplant or as destination therapy for patients with end-stage heart failure. Although cardiac offloading from these devices rarely leads to complete remodeling and functional recovery, the use of mesenchymal cells to modulate heart failure has been explored in recent years due to its intrinsic regenerative properties. Current methods of evaluating cardiac function have too much variability, difficulty of access, or require too frequent follow up to create universal weaning protocols. We hypothesized that the administration of amniotic allograft liquid matrix (LM) containing amnion-derived mesenchymal stem cells (aMSCs) in …

Guideline-Directed Heart Failure Therapy In Patients After Left Ventricular Assist Device Implantation, Bailey M. Colvin, James C. Coons, Craig J. Beavers

The VAD Journal

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 in patients with LVADs.

Methods: Articles were found using PubMed and web searches for heart failure therapies/neurohormonal blockade and LVADs. Studies were included if they …

Approach To Unresponsive Patient With Lvad, Maya Guglin

The VAD Journal

No abstract provided.

What Did We Learn About Vads In 2016?, Maya Guglin

The VAD Journal

No abstract provided.

Cardiomems™ In Lvad Patients: A Case Series, Maya Guglin, Bennet George, Sarah Branam, Amanda Hart

The VAD Journal

Patients with a left ventricular assist device (LVAD) commonly encounter issues with volume status post-implant. Volume overload can result from incomplete compensation of left ventricular failure or from right ventricular failure. The CardioMEMS™ intracardiac hemodynamic monitoring device is an area of growing interest regarding the management of chronic congestive heart failure, however, its utility has not been serially investigated in patients with an LVAD. We present a case series of patients with ventricular assist devices care for at our institution in which the CardioMEMS™ device aided in the management of volume status and pump performance.

Ligation Of The Outflow Graft Of The Left Ventricular Assist Device For Management Of Hemolysis Due To Pump Thrombosis, Jean Touchan, Alexis Shafii, Maya Guglin

The VAD Journal

Pump thrombosis is a serious complication of continuous-flow left ventricular assist devices (LVAD). Treatment options include medical thrombolysis, surgical pump exchange or urgent heart transplantation. We are reporting a case of pump thrombosis with active hemolysis and acute renal failure managed surgically by isolating the LVAD while awaiting renal recovery and donor heart availability.

Caregiver Burden Is Low Nine To Twelve Months After Ventricular Assist Device Implantation, Roxana Ghashghaei, Hao Tran, Jorge Silva, Barry H. Greenberg, Denise Barnard, Eric Adler

The VAD Journal

Background:

Prior studies have found that caregivers of chronically ill patients, including those with heart failure, have significant stress and burden. Ventricular Assist Devices (VADs) are a promising therapeutic modality for end stage heart failure. However, caregiver burden has not previously been studied in the caregivers of VAD patients.

Methods:

We studied 31 caregivers of VAD patients receiving care at University of California, San Diego. Validated instruments tools, such as the Bakas Caregiving Outcomes scale and Oberst Caregiving Demand and Difficulty sub-scales, were used to measure the caregivers’ psychological burden.

Results:

Nearly half of the caregivers were the patient’s spouse …

Normal Lactate Dehydrogenase Does Not Exclude Pump Thrombosis In Left Ventricular Assist Devices, Julie Shelton Do, Bennet George Md, Amanda Hart Bsn, Rn, Maya Guglin Md

The VAD Journal

Left ventricular assist device (LVAD) pump thrombosis is a well-known complication of LVAD placement. Elevated lactate dehydrogenase (LDH) has classically been the first objective marker of pump thrombosis. In this case, we present a patient found to have normal serum LDH values but was ultimately found to have significant pump thrombosis.

Outcomes Of External Repair Of Heartmate Ii™ Lvad Percutaneous Leads, Jay D. Pal, Claudius Mahr, Jason W. Smith, Todd F. Dardas, Jay Pinette, David J. Farrar, Nahush A. Mokadam

The VAD Journal

Background: The HeartMate II Left Ventricular Assist Device (LVAD) receives power via a percutaneous lead connected to an external controller and batteries. At times, this lead can be damaged during normal wear, as well as by traumatic fracture, which may jeopardize the functionality of the LVAD. If there is significant internal damage, surgical replacement of the LVAD is required. However it is possible to repair externally damaged leads by replacing the distal portion of the lead to avoid pump replacement. We report the overall experience and outcomes in patients with external lead repairs.

Methods: A procedure for full …

A Protocol For Collecting Human Cardiac Tissue For Research, Cheavar A. Blair, Premi Haynes, Stuart G. Campbell, Charles Chung, Mihail I. Mitov, Donna Dennis, Mark R. Bonnell, Charles W. Hoopes, Maya Guglin, Kenneth S. Campbell

The VAD Journal

This manuscript describes a protocol at the University of Kentucky that allows a translational research team to collect human myocardium that can be used for biological research. We have gained a great deal of practical experience since we started this protocol in 2008, and we hope that other groups might be able to learn from our endeavors. To date, we have procured ~4000 samples from ~230 patients. The tissue that we collect comes from organ donors and from patients who are receiving a heart transplant or a ventricular assist device because they have heart failure. We begin our manuscript by …

The Utility Of Remote Hemodynamic Monitoring Devices In Patients With A Ventricular Assist Device, Bennet George, Amanda Hart, Sarah Branam, Maya Guglin

The VAD Journal

Remote intracardiac hemodynamic monitoring is a growing area of interest to help aid in the management of patients with chronic congestive heart failure. The utility of remote hemodynamic monitoring has not previously been investigated with a ventricular assist device population. We present two cases of patients with ventricular assist devices in which we employed remote hemodynamic monitoring data to aid in patient management.

Speech At The Reception For Dr. Frazier At The Ishlt 2016. Remarks For O.H. Frazier, M.D., Edwin C. Mcgee Jr

The VAD Journal

No abstract provided.

Bleeding And Thromboembolic Events In Patients With Heartmate Ii Mechanical Circulatory Support, Salman Allana, Carrie Chapman, Nancy Sweitzer, Maryl Johnson, Takushi Kohmoto, Margaret Murray, David Murray, Zhanhai Li, Peter S. Rahko

The VAD Journal

Background: Bleeding and thromboembolic events (TE) are common complications following HeartMate II (HMII) implantation. The aim of the study was to review our experience related to bleeding and TE events in patients with a HMII and identify factors associated with increased risk of these events.

Methods: We retrospectively reviewed 70 consecutive patients who received a HMII between May 2006 and December 2011. The patients were followed for 12 months or until cardiac transplantation, device explantation or death. Major bleeding was defined by INTERMACS criteria with intracranial bleeding events added.

Results: There were 48 bleeding events in 28 (40%) patients with …

Decrease In Driveline Infections With Change In Driveline Management Protocol, Saima Aslam, Jennifer Dan, Amanda Topik, Michael Belyk, Francesca Torriani, Randy Taplitz, Jorge Silva-Enciso, Denise Barnard, Barry Greenberg, Jack Copeland, Victor Pretorius, Eric Adler

The VAD Journal

Background: Driveline infections (DLI) are a significant cause of morbidity and mortality in ventricular assist device (VAD) recipients. We compared driveline infection (DLI) rate after an institutional change in driveline management protocol.

Methods: We retrospectively reviewed records of left VAD recipients at our institution, based on driveline management. Group 1: daily driveline dressing change consisting of chlorhexidine cleansing, sterile 4x4 gauze, and use of an abdominal binder. Group 2: Dressing change every 3 days consisting of chlorhexidine cleansing, non-sterile silver-impregnated foam with overlying clear dressing, and use of a driveline anchor. Follow-up was censored at first DLI, device removal, transplant …

St-Segment Elevation Myocardial Infarction In Patient With Left Ventricular Assist Device, Navin Rajagopalan, Ryan E. Wilson

The VAD Journal

Acute myocardial infarction is a rare event in a patient with a left ventricular assist device (LVAD). We present a case of ST-segment elevation myocardial infarction in a LVAD patient.

What Did We Learn About Vads In 2014?, Maya Guglin

The VAD Journal

No abstract provided.

Surgical Considerations Of Lvad Implantation In Patients With Prosthetic Valves, Igor D. Gregoric

The VAD Journal

No abstract provided.

Successful Left Ventricular Assist Device Support In Patient With Bjork-Shiley Mitral Valve Replacement, Navin Rajagopalan, David C. Booth

The VAD Journal

There is limited clinical experience with left ventricular assist device therapy in patients with prosthetic mitral valves. We present a case of successful left ventricular assist device support in a patient with previous mechanical mitral valve replacement.

Heartmate Ii Post-Marketing Clinical Studies To Further Establish And Expand Lvad Therapy, Faouzi Kallel

The VAD Journal

No abstract provided.

Left Ventricular Assist Device As Destination Therapy, Maya Guglin, Leslie W. Miller

The VAD Journal

Mechanical circulatory support is the most rapidly evolving strategy in heart failure management. The growing number of patients who need better results than medical therapy can offer, the limited pool of donors for cardiac transplantation, and several technological breakthroughs have all made the option of implanting a left ventricular assist device (LVAD) as destination therapy more important.

In this review, we outline the indications and decision making process of considering a patient for a destination therapy LVAD, as well as outcomes, complications, and issues related to management of patients on currently approved devices. The future direction of the field will …