Medicine and Health Sciences Commons^™

Low-Dose Vitamin K Can Improve Warfarin Control In Patients On Lvad Support, Daizo Tanaka, Venessa L. Kotch, Cheryl Abbas, Gordon Reeves, John Wc Entwistle Iii

The VAD Journal

Background

Anticoagulation with oral vitamin K antagonists (VKA) is very important in patients supported on a left ventricular assist device (LVAD) to prevent thromboembolic complications. Some patients tolerate VKAs poorly and have an unstable INR as a result. It is reported that low-dose vitamin K can improve INR control in patients with an unstable INR in other clinical settings. We evaluated its safety and effectiveness in patients on LVAD support.

Methods

The records of all patients supported on an implantable LVAD between January, 2013 and March, 2014 were reviewed retrospectively to identify those who had received low-dose vitamin K while …

Damaging Cardiac And Cancer Genetic Variants In The Lvad Population, Brian D. Lowes Md, Phd, Eric T. Rome, Kajari Dhar, Jeff Kittrell, James D. Eudy, John Y. Um, Alexandra Moulton, J. Zao, Ronald Redder, Michael J. Moulton, Daniel R. Anderson, Eugenia Raichlin

The VAD Journal

Background: Next generation sequencing technology, coupled with population genetic databases, have made broad genetic evaluation relatively inexpensive and widely available. Our objective was to assess the prevalence of potentially damaging cancer and cardiac gene variants in advanced non-ischemic cardiomyopathy patients.

Methods: Explanted human heart tissue procured at LVAD placement was obtained from the University of Nebraska Medical Center Heart Tissue Bank. Genomic DNA was isolated from tissues and amplified by PCR using targeted ampliseq primer pools from an inherited disease panel. Individual libraries were amplified by emulsion PCR on Ion Sphere particles and sequencing was performed on a …

Early Manifestations Of Atrial Tamponade In A Patient Implanted With Syncardia Total Artificial Heart., Manoj Thangam, Bindu Akkanti, Sriram Nathan, Daniel Ocazionez-Trujillo, Indranee Rajapreyar, Manish K. Patel, Jayesh Patel, Pranav Loyolka, Biswajit Kar, Igor Gregoric

The VAD Journal

Implantation rates of the SynCardia Total Artificial Heart (TAH) system is growing owing to the increasing incidence of biventricular heart failure and the limited number of transplantable hearts. Among the complications associated with the device, atrial tamponade is an emergent condition that requires immediate attention. Atrial tamponade occurs when increasing pericardial hemorrhage leads to atrial compression that produces tamponade physiology and compromises cardiac output. Unfortunately to our knowledge, information concerning the early manifestations of tamponade in TAH patients is extremely scarce. Previous reports have focused on decreased cardiac output as an indicator of tamponade. However, other presentations including pulmonary decompensation …

Massive Pulmonary Embolism With Hemodynamic Compromise Successfully Treated With Veno-Arterial Extracorporeal Membrane Oxygenation, B. Akkanti, S. Nathan, E. N. Centeno, K. Akasapu, P. Doshi, R. Hussain, F. Raissi, A. Nascimbene, R. Srinivasan, I. Rajapreyar, M. Patel, J. Patel, M. Akay, P. Loyalka, B. Kar, I. Gregoric

The VAD Journal

Introduction: Cardiogenic shock that results from pulmonary embolus has a high mortality rate. Systemic thrombolysis is frequently used in submassive and massive pulmonary embolus and has been shown to restore circulation. However, in the event of impending or ongoing cardiac arrest, systemic thrombolysis or anticoagulation alone has not been always shown to be effective. Case reports have previously established that extracorporeal membrane oxygenation can effectively be used as an effective rescue strategy in cases of cardiac arrest as a result from massive pulmonary embolus. We report six cases of massive pulmonary embolism (PE), in which veno-arterial extracorporeal membrane oxygenation (VA …

Systemic Candidiasis And Cytomegalovirus Infection In The Setting Of Artificial Cardiac Device Deployment., Manoj Thangam, Bindu Akkanti, Maan Malahafio, Sriram Nathan, Indranee Rajapreyar, Pranav Loyalka, Biswajit Kar, Igor Gregoric

The VAD Journal

Heart failure is a serious cause of morbidity and mortality worldwide. The advent of implantable cardiac assist devices has generated a new arsenal for treating severe heart failure. However, the potential ramifications of ventricular assist device (VAD) usage are not fully understood. Immune modulation resulting from VAD implantation is an area of growing research. Although we do not fully understand the mechanisms contributing to host immune alteration, changes in cytokine concentrations, deceased lymphocyte activity, and the local effects of device materials have been shown to down regulate immune function. ^7,8 Infection is a serious complication that affects prognosis in this …

Commentary On "Systemic Candidiasis And Cytomegalovirus Infection In The Setting Of Artificial Cardiac Device Deployment", Moises A. Huaman

The VAD Journal

No abstract provided.

Use Of Social Media As A Virtual Community And Support Group By Left Ventricular Assist Device (Lvad) Patients, Bryan Boling, Amanda Hart, Chizimuzo T.C. Okoli, Tamra Halcomb, Peggy El-Mallakh

The VAD Journal

Abstract

Background

Left ventricular assist device (LVAD) patients may benefit from participating in a social support group; however, several factors may limit the availability of these communities. Alternatively, online social support communities may be more accessible for LVAD patients. No studies have examined patterns and reasons for health-related social media use among people with LVADs

Methods

An online survey of patients actively participating in LVAD social media groups was conducted using both multiple choice and open-ended questions.

Results

Thirty-nine participants (65% male) completed the survey. Participants’ reasons for weekly engagement in online communities were to seek (69.2%) and offer (66.7%) …

Chronic Ldh Elevation After Left Ventricular Assist Device Implantation, Hesham R. Omar, Navin Rajagopalan, Maya Guglin

The VAD Journal

A 61-year-old woman who underwent HeartMate II left ventricular assist device placement for non-ischemic cardiomyopathy developed elevated lactate dehydrogenase within two weeks after implantation. After eight months of observation and several hospital admissions during which there was no evidence of pump thrombosis, she presented with clinically manifest hemolysis. During pump exchange there was notable pannus formation on the inflow cannula of the left ventricular assist device. The pannus around the inflow likely existed for several months, limiting the flow and creating a low-grade hemolysis and this low flow state stimulated thrombus formation triggering gross hemolysis. Thoratec analysis of the pump …

Chronic Hemodialysis In A Patient With Left Ventricular Assist Device., Amr Idris, Georges Lolay, Ana L. Castellanos, Navin Rajagopalan, Maya Guglin

The VAD Journal

Renal dysfunction in the setting of heart failure is a common medical problem. This dysfunction can range from reversible ischemic changes to renal failure requiring renal replacement therapy. Patients who are candidates for mechanical circulatory support with left ventricular assistant device (LVAD) pose unique challenge with respect to receiving dialysis. We present a 47 year old patient who required renal replacement therapy peri-implantation of LVAD for management of acute on chronic kidney disease, and was discharged for chronic hemodialysis in an outpatient setting. In this report we highlight the challenges of managing volume overload in patients with impaired renal function …

Veraflo Negative Pressure Wound Therapy With Household Bleach For Refractory Driveline Infection In A Patient With Left Ventricular Assist Device., Amr Idris, Amanda Hart, Sarah Branam, Maya Guglin

The VAD Journal

Driveline infections and sepsis are amongst the most common causes of morbidity and mortality in a patient with a left ventricular assist device. In this case, we present a patient with a multi drug resistant pseudomonas aeruginosa driveline exit site infection. Initially, it was treated with dual antibiotics, followed by surgical debridement utilizing Dakin’s solution irrigation and standard negative pressure wound therapy. Wound healing was minimal determined by poor granulation appearance, unchanged size from surgical debridement, purulent drainage, and the wound base remained colonized with multi drug resistant pseudomonas aeruginosa. A novel treatment of VeraFlo negative pressure wound therapy in …

Inotropes Are Linked To Increased Mortality In Heart Failure, M. Chadi Alraies, Bill Tran, Sirtaz Adatya

The VAD Journal

No abstract provided.

Inotropes Are Not Linked To Increased Mortality In Heart Failure, Maya Guglin

The VAD Journal

How to use inotropes is one of the most controversial topics in the management of heart failure. While most clinicians use these drugs, and recognize the state of inotrope dependency, current guidelines recommend them onlu as a bridge or palliation. Thus, inotropes are considered either neutral or detrimental in terms of outcomes. Meanwhile, properly designed randomized clinical trials testing the outcomes on inotropes, have never been performed and it is unlikely that they will ever be attempted. These trials would require randomizing patients with advanced heart failure, low output syndrome, and impaired end-organ perfusion into groups that received or not …

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.

Old Dog, New Tricks - Usefulness Of The Ecg In Monitoring Acute Rejection Post Cardiac Transplantation, Paul Anaya, Samy-Claude Elayi

The VAD Journal

Electrocardiographic abnormalities have been described in the setting of acute rejection following orthotopic cardiac transplantation. The following is a brief commentary related to an interesting case report by Goldraich et al. which was recently published in the VAD Journal.

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.

Old School Still Has Merit: Ecg As A Marker Of Cardiac Recovery At Weaning From Mechanical Circulatory Support, Livia Adams Goldraich, Vivek Rao, Fillio Billia, Heather Joan Ross

The VAD Journal

In a case of acute cardiac allograft failure requiring temporary mechanical circulatory support (MCS), serial electrocardiograms (ECG) denoted the degree of myocardial inflammation and damage caused by severe rejection and subsequent recovery. This case highlights the relevance of the ECG during temporary MCS and suggests that resolution of acute electrocardiographic abnormalities might be a marker of myocardial recovery to help guide appropriate timing for weaning from MCS in the setting of acute graft failure.

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

The VAD Journal

No abstract provided.