Medicine and Health Sciences Commons^™

The Use Of Cardiomems In Dialysis Patients With Heart Failure, Karolina Viquez, Peggy Hardesty, Karim Fahmy, Amr Elhusseini, Mohamed Elyamny, Maya Guglin

The VAD Journal

In patients with chronic kidney disease (CKD) and heart failure (HF), volume overload is a major problem. Removal of fluid during the dialysis treatment, is the cornerstone management in these conditions but, assessing the amount of volume that should be removed is a challenge since physical exam findings are not accurate. Ambulatory pulmonary artery (PA) pressure measurement is a promising intervention in HF that potentially could be used as well in CKD population, predicting volume status changes and allowing a promptly intervention. We presented two cases of patient with CKD, HF and cardioMEMS

Hemodynamic, Therapeutic, And Clinical Outcomes Of Ambulatory Pressure-Guided Heart Failure Management, Jacob Abraham, Lian Wang, Rebecca Lewis, Katherine Callis, Joshua Remick, Kateri J. Spinelli

The VAD Journal

Background: Heart failure (HF) management guided by CardioMEMS™ pulmonary artery pressure (PAP) monitoring reduces PAP and HF hospitalizations. The objective of this project was to characterize the relationship between medication adjustments, PAP change, and outcomes for all patients at an advanced HF center.

Methods: We retrospectively analyzed medication changes and hospitalizations for 32 consecutive patients implanted with the CardioMEMS™ sensor at a single HF center and related these outcomes to PAP data from the Merlin.net (Abbott) database. Absolute change in PAP from baseline was estimated using area under the curve normalized to days monitored.

Results: Patients had an average change …

Restoration Of Left Ventricular Function Following Lvad Implantation – Remission Or Recovery? A Case Series., Shiksha Joshi, Mariah Barlow, Maya Guglin

The VAD Journal

Background

A wide range of left ventricular (LV) recovery rates on left ventricular assist device (LVAD) support have been reported. In this case series, we summarize our experience with LVAD explantation for presumed LV recovery.

Case series

Out of 240 patients who received an LVAD implant in our program since its inception, we explanted/inactivated the pump for presumed LV recovery in only three patients. All three of these patients had relapse of cardiomyopathy within 6 months of explantation.

Conclusion

Our experience does not support the existence of LV recovery following LVAD implantation as a common phenomenon. Improvement in LV function …

What Did We Learn About Vads In 2017?, Maya Guglin

The VAD Journal

No abstract provided.

Paranormal Activity: Para-Esophageal/Gastric Hemorrhage In A Patient With A Heartmate Ii Lvad, Anna Stone, Ashwin Ravichandran

The VAD Journal

In this report we present an unusual case of non-traumatic, spontaneous para-esophageal/para-gastric hemorrhage requiring multiple units of red blood cells in a female patient with a continuous flow left ventricular assist device. She presented with dysphagia and atypical chest pain 18 months post implantation, on the recommended anticoagulation regimen for HeartMate II support of ASA 81mg and international normalized ratio goal (INR) of 2-3 and was successfully managed with conservation support, volume resuscitation and multiple transfusions. Non-traumatic causes of acute bleeding, including acquired platelet dysfunction are considered.

Fatal Flaw - Driveline Fracture As A Rare But Serious Complication Of Mechanical Circulatory Support With Left Ventricular Assist Devices, Yuri Boyechko, Thomas Tribble, Maya Guglin

The VAD Journal

Background: Patients with advanced heart failure have seen decreased mortality and improved quality of life due to mechanical circulatory support with left ventricular assist devices (LVAD). Regardless of such outcomes, many complications still exist and remain a significant cause of morbidity and mortality. Our purpose is to study the prevalence, clinical course, and outcomes specifically of patients with LVAD driveline (DL) fractures.

Methods: This single-center, retrospective review included all patients at our institution who had continuous flow LVADs and experienced DL fracture/injury from January 2012 - December 2015.

Results: Thirteen of 110 LVAD patients (11.8%) had DL fractures (Table 1). …

Venoarterial Extracorporeal Membrane Oxygenation For Cardiogenic Shock: A Retrospective Analysis Based On The Etiology Of Shock, Andrew Burchett, Thomas Tribble, Richard Charnigo, Susan Smyth, Maya Guglin

The VAD Journal

Abstract:

Background: We performed a retrospective analysis to evaluate the efficacy of VA-ECMO support in cardiogenic shock based on various etiologies.

Methods: We retrospectively analyzed 99 patients supported with VA-ECMO from January 1, 2012 to January 1, 2015. Outcomes included survival to discontinuation of VA-ECMO support and survival to hospital discharge. The etiologies of cardiogenic shock included cardiac arrest (CPR), acute myocardial infarction (AMI), decompensated congestive heart failure (CHF), pulmonary embolism (PE), right ventricular failure (RVF) not secondary to an acute pulmonary embolism, and post-cardiotomy syndrome (PCS). The PCS group was used as a reference group; odds ratios were estimated …

Common Clinical Dilemmas In Left Ventricular Assist Device Therapy: A Glimpse Into Current Trends, Ahmet Kilic, Michael S. Kiernan, Meredith A. Brisco-Bacik, Sangjin Lee, Behzad Soleimani, Aditya Bansal, Igor Gosev, Peter Eckman, Brian Lima, Brian Bethea, Chetan B. Patel, Jason N. Katz, Jonathan D. Rich, Susan M. Joseph

The VAD Journal

Background

Left ventricular assist device (LVAD) therapy has been thrust into the forefront of surgical treatment for advanced heart failure (HF). Despite advancements in survival and quality of life with these devices, the multi-disciplinary care for these patients remains far from standardized across institutions.

Methods

A survey of current practices in LVAD was carried out at the St. Jude Medical User’s meeting representing a variety of caregivers including cardiac surgeons, HF cardiologists, non-HF cardiologists, advanced practice providers and ventricular assist device coordinators, with representation from several continents. Utilizing an audience response system, eleven questions were asked related to the demographics …

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

The VAD Journal

No abstract provided.

Tolerability Of Intermittent Hemodialysis In A Cohort Of Patients With Left Ventricular Assist Device, Christopher Areephanthu, Amr Elhusseini, Bennet George, Jessica Mcabee, B. Peter Sawaya

The VAD Journal

Background: The use of left ventricular assist device (LVAD) has emerged as a popular treatment for patients with advanced heart failure. It is not uncommon for these patients to suffer from renal failure requiring renal replacement therapy. The purpose of this study is to assess hemodynamic parameters and ability to complete the prescribed hemodialysis session in a series of patients who underwent numerous dialysis treatments.

Methods: Nine patients with Heart Mate II LVAD received 170 intermittent inpatient hemodialysis treatments between January 1, 2010 and December 31, 2012. Assessment included vital signs, ultrafiltrate removed, hemodialysis duration, symptoms, early terminations (ET), and …

Adverse Events In Continuous-Flow Lvad Recipients: Gastrointestinal Bleeding Is Still Notable?, Marija Petrovic, Sriram Nathan, Rajko Radovancevic, Indranee Rajapreyar, Kevin J. Dasher, Mehmet H. Akay, Bindu Akkanti, Pranav Loyalka, Biswajit Kar, Igor D. Gregoric

The VAD Journal

Background: The etiology and risk factors associated with gastrointestinal bleeding (GIB) in patients with continuous-flow left ventricular assist devices (CF-LVADs) are currently unknown. Therefore, we sought to assess the risk factors for GIB in these patients.

Design and Methods: This was a retrospective, non-randomized, non-controlled study at a single center. Between 2012 and 2014, 65 men and 6 women (mean age = 55 ± 12 years) underwent CF-LVAD implantation at our institution. Overall, 23.9% of patients (17/71) had at least one GIB episode. Endoscopy confirmed GIB in 13/17. Arteriovenous malformation was the major GIB source in 8/13 (61%). …

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.

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.

Exploring Body Mass Index Changes In Left Ventricular Assist Device Patients, Raquel E. Thomas, Corrine Hanson, Glenda Woscyna, Brian D. Lowes

The VAD Journal

Background: Current treatment options for end-stage heart failure, such as transplantation, can be limited by obesity guidelines. Mechanical devices such as Left Ventricular Assistive Devices (LVAD) can bridge heart failure patients to transplantation, however, after implantation; some patients may experience weight gain that precludes them from transplantation. Therefore, the objective of this study was to evaluate weight changes after the implantation of an LVAD.

Methods: A retrospective review of 130 patients receiving an LVAD were divided into two groups based on BMI at the time of implantation: obese (>30 kg/m²) and non-obese (/m²). Patients were …

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.

Va-Ecmo In Cardiogenic Shock In Adults: Indications And Outcomes, Maya Guglin, Andrew Burchett

The VAD Journal

Background

Use of veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) has become increasingly common as a means of providing hemodynamic support for patients in cardiogenic shock. Data regarding the efficacy of VA-ECMO are provided almost exclusively by single-center, retrospective analyses. These retrospective analyses vary significantly with regards to documentation of the underlying pathophysiologic process resulting in cardiogenic shock.

Methods

Relevant published studies were identified by using a comprehensive search of English-language MEDLINE from 1966 to November 2015. Relevant references found cited in these studies were also analyzed. These studies were analyzed with regard to the indications the authors used for initiation of …

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 …

What Did We Learn About Vads In 2015?, Maya Guglin

The VAD Journal

No abstract provided.

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.

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 …