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This study aimed to evaluate thrombosis and bleeding events in the children implanted with two types of ventricular assist devices (VAD). A total of 26 paediatric end-stage heart failure patients with the mean age of 11.32 ± 4.17 years, 15 were boys, implanted with a VAD, either the Berlin Heart EXCOR (BHE group; n = 9) or the HeartWare (HW group, n = 17), were included in this retrospective study. Follow up data on bleeding events, thrombosis events, bridge-to-transplantation rates and survival outcome were recorded. Overall, 16(33.3%) bleeding events and 32(66.7%) thrombosis events occurred, while 14(53.8%) patients had at least one thrombotic event and 8(30.8%) patients had at least one bleeding event. BHE and HW groups were similar in terms of number of patients with at least one thrombotic (33.3% vs. 64.7%, p = .218) or bleeding (22.2% vs.35.3%, p = .399) event. Mortality occurred in 9(34.6%) patients and 13(50.0%) patients achieved bridge-to-transplantation, similarly in BHE and HW groups (mortality: 44.4% vs. 29.4%, p = .667 and transplantation: 77.8% vs. 35.3%, p = .097). In conclusion, our findings revealed that VAD application in children with heart failure enables successful heart transplantation achievement with an acceptable risk of bleeding/thromboembolic events in most of cases. More advanced VAD technologies and more successful management for haematologic complications are necessary to improve the transplantation rates in children.
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OBJECTIVES: The use of ventricular assist devices (VADs) in children is increasing. However, absolute numbers in individual centres and countries remain small. Collaborative efforts such as the Paedi-European Registry for Patients with Mechanical Circulatory Support (EUROMACS) are therefore essential for combining international experience with paediatric VADs. Our goal was to present the results from the fourth Paedi-EUROMACS report. METHODS: All paediatric (<19 years) patients from the EUROMACS database supported by a VAD were included. Patients were stratified into a congenital heart disease (CHD) group and a group with a non-congenital aetiology. End points included mortality, a transplant and recovery. Cox proportional hazard models were used to explore associated factors for mortality, cerebrovascular accident and pump thrombosis. RESULTS: A total of 590 primary implants were included. The congenital group was significantly younger (2.5 vs 8.0 years, respectively, P < 0.001) and was more commonly supported by a pulsatile flow device (73.5% vs 59.9%, P < 0.001). Mortality was significantly higher in the congenital group (30.8% vs 20.4%, P = 0.009) than in the non-congenital group. However, in multivariable analyses, CHD was not significantly associated with mortality [hazard ratio (HR) 1.285; confidence interval (CI) 0.8111-2.036, P = 0.740]. Pump thrombosis was the most frequently reported adverse event (377 events in 132 patients; 0.925 events per patient-year) and was significantly associated with body surface area (HR 0.524, CI 0.333-0.823, P = 0.005), CHD (HR 1.641, CI 1.054-2.555, P = 0.028) and pulsatile flow support (HR 2.345, CI 1.406-3.910, P = 0.001) in multivariable analyses. CONCLUSIONS: This fourth Paedi-EUROMACS report highlights the increasing use of paediatric VADs. The patient populations with congenital and non-congenital aetiologies exhibit distinct characteristics and clinical outcomes.
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Corazón Auxiliar , Sistema de Registros , Humanos , Sistema de Registros/estadística & datos numéricos , Corazón Auxiliar/estadística & datos numéricos , Corazón Auxiliar/efectos adversos , Niño , Preescolar , Masculino , Femenino , Lactante , Europa (Continente)/epidemiología , Adolescente , Cardiopatías Congénitas/cirugía , Cardiopatías Congénitas/mortalidad , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/cirugía , Recién NacidoRESUMEN
We sought to investigate the impact of heart failure on anti-spike antibody positivity following SARS-CoV-2 vaccination. Our study included 103 heart failure (HF) patients, including those with and without left ventricular assist devices (LVAD) selected from our institutional transplant waiting list as well as 104 non-heart failure (NHF) patients who underwent open heart surgery at our institution from 2021 to 2022. All the patients received either heterologous or homologous doses of BNT162b2 and CoronaVac. The median age of the HF group was 56.0 (interquartile range (IQR): 48.0-62.5) and the NHF group was 63.0 (IQR: 56.0-70.2) years, and the majority were males in both groups (n = 78; 75.7% and n = 80; 76.9%, respectively). The majority of the patients in both the HF and NHF groups received heterologous vaccinations (n = 43; 41.7% and n = 52; 50.3%, respectively; p = 0.002). There was no difference in the anti-spike antibody positivity between the patients with and without heart failure (p = 0.725). Vaccination with BNT162b2 led to significantly higher antibody levels compared to CoronaVac alone (OR: 11.0; 95% CI: 3.8-31.5). With each passing day after the last vaccine dose, there was a significant decrease in anti-spike antibody positivity, with an OR of 0.9 (95% CI: 0.9-0.9). Furthermore, hyperlipidemia was associated with increased antibody positivity (p = 0.004).
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This study aimed to evaluate the effects of aortic valve opening patterns on endothelial functions in patients undergoing continuous-flow left ventricular assist device (CF-LVAD) implantation. This study included 43 patients who underwent CF-LVAD implantation and 35 patients with heart failure reduced ejection fraction (HFrEF; control group). The CF-LVAD group was divided into three subgroups based on aortic valve opening patterns: open with each beat, intermittently opening, and not opening groups. Flow-mediated dilatation (FMD) and pulsatility index (PI) were compared before and 3 months after CF-LVAD implantation. Cardiopulmonary exercise test (CPET) and 6 minute walk test (6-MWT) scores were measured at baseline and follow-up in the CF-LVAD group. The mean FMD and PI of patients in the CF-LVAD group reduced 3 months after implantation. Patients with intermittently opening and not opening aortic valves had worse endothelial function at follow-up. Before and 3 months after implantation FMD% did not significantly differ in patients whose aortic valves were open with each beat (4.72 ± 1.06% vs. 4.67 ± 1.16%, p = 0.135). Pulsatility index changes paralleled FMD changes. Cardiopulmonary exercise test and 6-MWT scores improved after implantation but without significant differences between subgroups. Maintaining normal aortic valve function after CF-LVAD implantation may reduce endothelial dysfunction; however, larger studies are needed for long-term clinical effects.
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End-stage Fontan patients with single-ventricle (SV) circulation are often bridged-to-heart transplantation via mechanical circulatory support (MCS). Donor shortage and complexity of the SV physiology demand innovative MCS. In this paper, an out-of-the-box circulation concept, in which the left and right ventricles are switched with each other is introduced as a novel bi-ventricle MCS configuration for the "failing" Fontan patients. In the proposed configuration, the systemic circulation is maintained through a conventional mechanical ventricle assist device (VAD) while the venous circulation is delegated to the native SV. This approach spares the SV and puts it to a new use at the right-side providing the most-needed venous flow pulsatility to the failed Fontan circulation. To analyze its feasibility and performance, eight SV failure modes have been studied via an established multi-compartmental lumped parameter cardiovascular model (LPM). Here the LPM model is experimentally validated against the corresponding pulsatile mock-up flow loop measurements of a representative 15-year-old Fontan patient employing a clinically-approved VAD (Medtronic-HeartWare). The proposed surgical configuration maintained the healthy cardiac index (3-3.5 l/min/m2) and the normal mean systemic arterial pressure levels. For a failed SV with low ejection fraction (EF = 26%), representing a typical systemic Fontan failure, the proposed configuration enabled a ~ 28 mmHg amplitude in the venous/pulmonary waveforms and a 2 mmHg decrease in the central venous pressure (CVP) together with acceptable mean pulmonary artery pressures (17.5 mmHg). The pulmonary vascular resistance (PVR)-SV failure case provided a ~ 5 mmHg drop in the CVP, with venous/pulmonary pulsatility reaching to ~ 22 mmHg. For the high PVR failure case with a healthy SV (EF = 44%) pulmonary hypertension is likely to occur as expected. While this condition is routinely encountered during the heart transplantation and managed through pulmonary vasodilators a need for precise functional assessment of the spared failed-ventricle is recommended if utilized in the PVR failure mode. Comprehensive in vitro and in silico results encourage this novel concept as a low-cost, more physiological alternative to the conventional bi-ventricle MCS pending animal experiments.
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Procedimiento de Fontan , Corazón Auxiliar , Animales , Humanos , Adolescente , Ventrículos Cardíacos , Hemodinámica/fisiología , Corazón , Resistencia Vascular , Modelos CardiovascularesRESUMEN
BACKGROUND: Studies revealing the relationship between major surgery outcomes and nutritional parameters are increasing daily. Publications demonstrating the relationship between early postoperative success and surgical complications in patients with chronic heart failure and continuous flow left ventricular assist device (cf-LVAD) are limited. The vast majority of patients with advanced chronic heart failure are cachexic, and the reason for this is multifactorial. The aim of this study is to investigate the link between the modified nutritional risk index (NRI) and 6-month survival and complication rates in patients with a cf-LVAD. METHODS: This study included statistical analysis of NRI and postoperative parameters of 456 patients with advanced heart failure who had cf-LVAD implantation between 2010 and 2020. RESULTS: The results of this study showed a statistically significant difference between mean NRI values and postoperative parameters such as 6-month survival (P = .001), right ventricular failure (P = .003), infection (P = .001), driveline infection (P = .000), and sepsis (P = .000). CONCLUSIONS: This study revealed that 6-month postoperative complications and mortality rates of patients with advanced heart failure in patients with cf-LVAD are closely related to malnutrition status. In these patients, nutrition specialist use would be beneficial both preoperatively and postoperatively to increase surveillance and reduce postoperative complications.
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Insuficiencia Cardíaca , Corazón Auxiliar , Desnutrición , Adulto , Anciano , Persona de Mediana Edad , Adulto Joven , Enfermedad Crónica , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/cirugía , Insuficiencia Cardíaca/terapia , Corazón Auxiliar/efectos adversos , Desnutrición/complicaciones , Desnutrición/diagnóstico , Complicaciones Posoperatorias , Factores de Riesgo , HumanosRESUMEN
BACKGROUND: Patients who have performed solid organ transplantation in terms of COVID-19 infection are included in the high-risk group. In this study, it was aimed to evaluate the relationship between vaccination and retrospective evaluation of 32 patients who underwent a heart transplant in the clinic and tested positive for SARS-CoV-2 polymerase chain reaction. METHODS: In this study, demographic characteristics of the cases, comorbidities, timing of heart transplantation, immunosuppressive treatments, symptoms of COVID-19 infection, lung imaging findings, follow-up (outpatient/inpatient), treatments, 1-month mortality, and vaccination histories against COVID-19 infection were evaluated. The data obtained from the study were analyzed with SPSS version 25.0. RESULTS: The 3 most common symptoms are cough (37.5%), myalgia (28.1%), and fever (21.8%). COVID-19 infection was severe in 6.2% of the patients, moderate in 37.5%, and mild in 56.2%. Hospitalization was required in 5 patients (15.6%, 1 in the intensive care unit), and the other patients were followed up as an outpatient. Severe COVID-19 infection was seen more in 33% of unvaccinated patients; 93.5% were vaccinated. Nineteen patients (68%) were vaccinated before COVID-19 infection. Our patients received the CoronoVac (Sinovac, China) vaccine. CONCLUSION: COVID-19 infection is more likely to be severe and mortal in patients with heart transplant recipients. It is also crucial to comply with preventive measures other than immunization in this group of patients. This study is the largest series investigating COVID-19 infection in heart transplant recipient patients in our country.
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Vacunas contra la COVID-19 , COVID-19 , Trasplante de Corazón , Humanos , COVID-19/prevención & control , Vacunas contra la COVID-19/efectos adversos , Trasplante de Corazón/efectos adversos , Pacientes Ambulatorios , Estudios Retrospectivos , SARS-CoV-2 , Receptores de TrasplantesRESUMEN
Left ventricular assist device (LVAD) systems are preferred as a bridging to transplantation or as a destination therapy in the treatment of end-stage heart failure. LVAD-related complications are seen in different clinical variations with the widespread use of LVADs. Some of these complications are seen as related to outflow graft, such as graft stenosis, graft kinking and graft thrombosis. Outflow graft complications have a direct impact on LVAD flow rate and acutely impair the clinical condition of patients. Treatment modalities include surgical approach, endovascular approach, and medical approach. In this case report, we aim to share a 57-year-old male patient, who had outflow graft stenosis near the anastomosis line between ascending aorta and the left ventricular assist device outflow graft, and the endovascular treatment.
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BACKGROUND: Mechanical circulatory support technology continues to evolve to satisfy the needs of advanced heart failure patients. Despite improvements, various problems occur frequently, and surgical exchange of the pump can be a feasible treatment option. Optimal patient selection is key to success in exchange operations. METHODS: Using a retrospective observational cohort design, this study aims to evaluate preoperative profiles and clinical courses of patients' undergoing a device exchange operation and identified possible contributors to in-hospital mortality. Currently, 155 left ventricular assist device (LVAD) patients are being followed up in our program. In total, 15 of 155 patients underwent a pump exchange operation. Baseline characteristics, clinical features, and laboratory results were evaluated. The primary outcome was all-cause in-hospital mortality. RESULTS: Of the 15 patients who underwent a pump exchange operation, thrombosis was the primary cause in 12. Five patients experienced in-hospital mortality within 30 days of LVAD exchange. The international normalized ratio (INR) was higher in patients who experienced in-hospital mortality (2.4 [±0.6] vs 1.2 [±0.4], P = .005) than in patients who survived to discharge. In addition, preoperative lactate levels were significantly higher in patients who died within 30 days (2.9 [±2.6] vs 0.9 [±0.4], P = .019). CONCLUSIONS: Higher INR and lactate levels could possibly contribute to in-hospital mortality, which underlines the importance of right ventricular function in this patient population. Careful evaluation of the right heart function is of great importance before exchange operations, and preoperative hemodynamic stability is crucial for better postoperative outcomes.
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Insuficiencia Cardíaca , Corazón Auxiliar , Humanos , Estudios Retrospectivos , Corazón Auxiliar/efectos adversos , Resultado del Tratamiento , Insuficiencia Cardíaca/cirugía , LactatosRESUMEN
Background: The aim of this study was to describe clinical characteristics, course, and outcomes of the novel coronavirus disease 2019 (COVID-19) in heart failure patients with left ventricular assist device. Methods: Between November 2020 and August 2021, a total of 20 patients (18 males, 2 females; mean age: 57.0+10.0 years; range, 30 to 71 years) with left ventricular assist device and who were diagnosed by the COVID-19 polymerase chain reaction testing were included. For each patient, disease-related factors were evaluated including presence of hospitalization, home quarantine, presence of lung damage, antiviral medication strategy, symptomatology and complications following COVID-19. Results: Seven patients 35% patients died in our cohort following the COVID-19. All these patients experienced variety of complications following COVID-19 including subarachnoid hemorrhage and right heart failure. Three patients were already hospitalized due to COVID-19 and decompensated progressively, resulting in death on Days 14, 4, and 7 after the initial diagnosis. Conclusion: COVID-19 seems to be an important cause of mortality in patients with LVAD who have borderline cardiopulmonary function. Great care should be taken to avoid interruption in routine follow-ups with these patients, since they present a more sensitive population.
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OBJECTIVES: Ventricular assist device support as a bridge to transplant or recovery is a well-established therapy in children on the cardiac transplant waiting list. The goal of this study was to investigate the incidence of and the associated factors for cerebrovascular accidents in paediatric patients supported by a Berlin Heart EXCOR. METHODS: All patients <19 years of age supported by a Berlin Heart EXCOR between January 2011 and January 2021 from the European Registry for Patients with Mechanical Circulatory Support were included. RESULTS: In total, 230 patients were included. A total of 140 (60.9%) patients had a diagnosis of dilated cardiomyopathy. 46 patients (20.0%) sustained 55 cerebrovascular accidents, with 70.9% of the episodes within 90 days after the ventricular assist device was implanted. The event rate of cerebrovascular accidents was highest in the first era (0.75). Pump thrombosis and secondary need for a right ventricular assist device were found to be associated with a cerebrovascular accident (hazard ratio 1.998, P = 0.040; hazard ratio 11.300, P = 0.037). At the 1-year follow-up, 44.4% of the patients had received a transplant, 13.1% were weaned after recovery and 24.5% had died. Event rates for mortality showed a significantly decreasing trend. CONCLUSIONS: Paediatric ventricular assist device support is associated with important adverse events, especially in the early phase after the device is implanted. Pump thrombosis and the need for a secondary right ventricular assist device are associated with cerebrovascular accidents. Furthermore, an encouragingly high rate of recovery in this patient population was shown, and death rates declined. More complete input of data into the registry, especially concerning anticoagulation protocols, would improve the data.
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Insuficiencia Cardíaca , Trasplante de Corazón , Corazón Auxiliar , Accidente Cerebrovascular , Niño , Trasplante de Corazón/efectos adversos , Corazón Auxiliar/efectos adversos , Humanos , Incidencia , Modelos de Riesgos Proporcionales , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Resultado del TratamientoRESUMEN
OBJECTIVES: A third paediatric report has been generated from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). The purpose of EUROMACS, which is operated by the European Association for Cardio-Thoracic Surgery, is to gather data related to durable mechanical circulatory support for scientific purposes and to publish reports with respect to the course of mechanical circulatory support therapy. Since the first report issued, efforts to increase compliance and participation have been extended. Additionally, the data provided the opportunity to analyse patients of younger age and lower weight. METHODS: Participating hospitals contributed pre-, peri- and long-term postoperative data on mechanical circulatory support implants to the registry. Data for all implants in paediatric patients (<19 years of age) performed from 1 January 2000 to 31 December 2020 were analysed. This report includes updates of patient characteristics, implant frequency, outcome (including mortality rates, transplants and recovery rates) as well as adverse events including neurological dysfunction, device malfunction, major infection and bleeding. RESULTS: Twenty-five hospitals contributed 537 registered implants in 480 patients. The most frequent aetiology of heart failure was any form of cardiomyopathy (59%), followed by congenital heart disease and myocarditis (15% and 14%, respectively). Competing outcomes analysis revealed that a total of 86% survived to transplant or recovery or are ongoing; at the 2-year follow-up examination, 21.9% died while on support. At 12 months, 45.1% received transplants, 7.5% were weaned from their device and 20.8% died. The 3-month adverse events rate was 1.59 per patient-year for device malfunction including pump exchange, 0.7 for major bleeding, 0.78 for major infection and 0.71 for neurological events. CONCLUSIONS: The overall survival rate was 79.2% at 12 months following ventricular assist device implant. The comparison of survival rates of the early and later eras shows no significant difference. A focus on specific subgroups showed that survival was less in patients of younger age (<1 year of age; P = 0.01) and lower weight (<20 kg; P = 0.015). Transplant rates at 6 months continue to be low (33.2%).
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Cardiopatías Congénitas , Insuficiencia Cardíaca , Corazón Auxiliar , Procedimientos Quirúrgicos Torácicos , Niño , Cardiopatías Congénitas/epidemiología , Cardiopatías Congénitas/cirugía , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/cirugía , Corazón Auxiliar/efectos adversos , Humanos , Sistema de Registros , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Frailty has been associated with morbidity and mortality in patients with heart failure and those who underwent cardiac surgery. We aimed to study the effect of frailty on cardiovascular outcomes and the reversibility of frailty after the left ventricular assist device (LVAD) implantation. A total of 51 consecutive patients (44 men; aged 54 ± 10 years) scheduled to undergo LVAD implantation were assessed for frailty (Fried's phenotype, frail ≥3/5), cognitive function (using Mini-Cog), and depression (utilizing Patient Health Questionnaire-9) before the surgery and 3 months afterward. Patients were observed for mortality and adverse events [all-cause readmission, bleeding, renal dysfunction, and ventricular fibrillation (VF)/sustained ventricular tachycardia (VT)] for 12 months. More than half of the patients (54%) were designated as frail. Although there was no statistical difference in mortality among frail and nonfrail patients, frail ones were more likely to have a prolonged length of stay [adjusted odds ratio (AOR) 14.9, 95% confidence interval 1.6 to 132.5, p = 0.01]. At the 3-month reassessment after operation, frailty and cognition rates were better (frailty score [lower is better]: 3 vs 1.5, p <0.0001; cognition score [higher is better]: 4.5 vs 5, p = 0.001), and patients had less depression (Patient Health Questionnaire-9 score [lower is better]: 8 vs 4, p <0.0001). Of the secondary outcomes, only postoperative VF/sustained VT reached statistical significance in being more common among frail patients than nonfrail ones (p = 0.02). Although frailty was not associated with mortality at 1 year, prolonged length of stay occurred more with frail LVAD patients. Frailty status, cognitive function, and depressive mood all improved in most patients after LVAD.
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Procedimientos Quirúrgicos Cardíacos , Fragilidad , Insuficiencia Cardíaca , Corazón Auxiliar , Anciano , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Anciano Frágil , Fragilidad/complicaciones , Fragilidad/epidemiología , Humanos , Factores de RiesgoRESUMEN
OBJECTIVES: In the third report of the European Registry for Patients with Mechanical Circulatory Support of the European Association for Cardio-Thoracic Surgery, outcomes of patients receiving mechanical circulatory support are reviewed in relation to implant era. METHODS: Procedures in adult patients (January 2011-June 2020) were included. Patients from centres with <60% follow-ups completed were excluded. Outcomes were stratified into 3 eras (2011-2013, 2014-2017 and 2018-2020). Adverse event rates (AERs) were calculated and stratified into early phase (<3 months) and late phase (>3 months). Risk factors for death were explored using univariable Cox regression with a stepwise time-varying hazard ratio (<3 vs >3 months). RESULTS: In total, 4834 procedures in 4486 individual patients (72 hospitals) were included, with a median follow-up of 1.1 (interquartile range: 0.3-2.6) years. The annual number of implants (range: 346-600) did not significantly change (P = 0.41). Both Interagency Registry for Mechanically Assisted Circulatory Support class (classes 4-7: 23, 25 and 33%; P < 0.001) and in-hospital deaths (18.5, 17.2 and 11.2; P < 0.001) decreased significantly between eras. Overall, mortality, transplants and the probability of weaning were 55, 25 and 2% at 5 years after the implant, respectively. Major infections were mainly noted early after the implant occurred (AER<3 months: 1.44 vs AER>3 months: 0.45). Bilirubin and creatinine levels were significant risk factors in the early phase but not in the late phase after the implant. CONCLUSIONS: In its 10 years of existence, EUROMACS has become a point of reference enabling benchmarking and outcome monitoring. Patient characteristics and outcomes changed between implant eras. In addition, both occurrence of outcomes and risk factor weights are time dependent.
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Insuficiencia Cardíaca , Corazón Auxiliar , Cirugía Torácica , Procedimientos Quirúrgicos Torácicos , Adulto , Insuficiencia Cardíaca/cirugía , Corazón Auxiliar/efectos adversos , Humanos , Sistema de Registros , Resultado del TratamientoRESUMEN
The peripheral vascular effects of continuous-flow left ventricular assist device (CF-LVAD) implantation are still unclear. The aim of the current study was to determine peripheral vascular function before and after implantation of CF-LVAD in patients with end-stage heart failure (HF), and to compare this data to age- and sex-matched chronic heart failure with reduced ejection fraction (HFrEF) patients. Forty-three consecutive end-stage HF patients (New York Heart Association [NYHA] class III/IV; three women and 40 men; mean age 53 ± 11 years) who planned to receive CF-LVAD implantation comprised the LVAD patient population, and their clinical characteristics, preoperative and third postoperative month peripheral vascular function assessment data including flow-mediated dilation (FMD) and pulsatility index (PI) assessed by ultrasound Doppler in brachial artery were compared to age- and sex-matched chronic, stable HFrEF patients (NYHA class II; five women and 30 men; mean age 51 ± 10 years). After CF-LVAD implantation, median FMD decreased from 5.4 to 3.7% (p < 0.001), and median PI decreased from 6.9 to 1.4 (p < 0.001). In patients with end-stage HF before CF-LVAD implantation, FMD and PI were significantly lower compared to the chronic HFrEF patients (FMD: 5.4% ± 0.9% vs. 7.6% ± 1.1%; p < 0.001, respectively) and (PI: 6.9 ± 1.3 vs. 7.4 ± 1.2; p = 0.023, respectively). The current study revealed impaired peripheral vascular function in the end-stage HF patients compared to stable HFrEF patients, and documented the deterioration of peripheral vascular function after CF-LVAD implantation. These results suggest that impaired peripheral vascular function in the CF-LVAD patients compared to preoperative assessment is a consequence of the nonpulsatile blood flow due to the continuous-flow mechanical support.
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Insuficiencia Cardíaca , Corazón Auxiliar , Adulto , Femenino , Insuficiencia Cardíaca/cirugía , Corazón Auxiliar/efectos adversos , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Volumen Sistólico , Función Ventricular IzquierdaRESUMEN
BACKGROUND: Left ventricular assist device (LVAD) implantation via thoracotomy with outflow cannula anastomosis to the descending aorta is an alternative implantation technique that uses a single incision and avoids anterior mediastinal planes. We evaluated long-term survival and hospital readmissions after LVAD implantation via thoracotomy with outflow cannula anastomosis to the descending aorta. METHODS: Adult patients implanted with a continuous flow centrifugal LVAD at an academic center were retrospectively analyzed. Patients were assigned to 1 of 2 cohorts based on the anastomosis site of the LVAD outflow cannula: ascending aorta cohort (Asc-Ao) and descending aorta cohort (Desc-Ao). Primary and secondary outcomes were survival and hospital readmissions during device support. Readmission analysis included patients with ≥30-day survival after discharge. Multivariable analysis and propensity score matching were performed. RESULTS: Survival analysis included 330 patients (Asc-Ao: 272, Desc-Ao: 58). Readmission analysis included 277 patients (Asc-Ao: 231, Desc-Ao: 46) and a total of 1028 readmissions during 654 patient-years of follow-up were analyzed. There was no significant difference in in-hospital, 6-month, 1-year, 3-year, and 5-year mortality between the two cohorts. Readmission-free survival, 30-day readmission, number of admissions per year and hospital length of stay per year were not significantly different between the 2 cohorts after adjustment for patient characteristics. CONCLUSIONS: This study found no difference in long-term survival or hospital readmissions between LVAD implantation via thoracotomy with outflow cannula anastomosis to the descending aorta and standard implantation.
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Insuficiencia Cardíaca , Corazón Auxiliar , Adulto , Anastomosis Quirúrgica , Aorta Torácica/cirugía , Cánula , Insuficiencia Cardíaca/cirugía , Humanos , Implantación de Prótesis/métodos , Estudios RetrospectivosRESUMEN
Cardiopulmonary exercise test (CPET) parameters are established prognosticators in heart failure. However, the prognostic value of preimplantation and postimplantation CPET parameters in left ventricular assist device (LVAD) therapy is unclear and it is evaluated in this study. Adult patients who were implanted with an LVAD and underwent CPET during the preimplantation or postimplantation period were retrospectively analyzed. Five CPET parameters were calculated: vO2 max, oxygen uptake efficiency slope (OUES), VE/vCO2 Slope, VE/vCO2 min, and VE/vCO2 max. The relationship between CPET parameters and postimplantation outcomes was evaluated with multivariable analysis. Pre and postimplantation CPET cohorts included 191 and 122 patients, respectively. Among preimplantation CPET parameters: vO2 max and OUES were associated with 1, 3, and 5 year mortality, VE/vCO2 min was associated with 3 and 5 year mortality, whereas VE/vCO2 Slope was associated with 5 year mortality. From postimplantation CPET parameters: vO2 max was an independent predictor of 3 and 5 year mortality, whereas VE/vCO2 max was an independent predictor of 3 year mortality following LVAD implantation. Preimplantation CPET parameters have a prognostic value for long-term survival following LVAD implantation, whereas their association with early postimplantation outcomes appears to be weaker. Postimplantation vO2 max and VE/vCO2 max values are associated with survival on device support and may provide a second chance for prognostication in patients without preimplantation CPET data.
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Insuficiencia Cardíaca , Corazón Auxiliar , Adulto , Prueba de Esfuerzo , Insuficiencia Cardíaca/cirugía , Humanos , Consumo de Oxígeno , Pronóstico , Estudios RetrospectivosRESUMEN
BACKGROUND: In this study, we aimed to investigate the effect of using autologous blood recovery systems on transfusion-related complications in patients undergoing lung transplantation and cardiovascular surgeries. METHODS: Between May 2016 and May 2019, a total of 104 patients (90 males, 14 females; mean age: 59.3±16.4 years; range, 12 to 89 years) in whom cell-saver and autologous blood recovery systems were used during lung transplantation or cardiovascular surgeries were retrospectively analyzed. The patients were divided into two groups as Group 1 (n=61) consisting of patients who received autologous blood transfusion and as Group 2 (n=43) consisting of patients who did not. Data including demographic and clinical characteristics of the patients, operation data, and postoperative complications were recorded. RESULTS: The total amount of transfused blood/blood product was found to be significantly higher in Group 1 (p=0.018). However, transfusionrelated complications were found to be higher in Group 2 (p=0.0261). There was no significant difference in the length of hospital stay between the groups. CONCLUSION: Autologous blood transfusion may prevent the development of transfusion-related complications by reducing the amount of allogenic transfusion in major surgical procedures. In our study, the autologous blood transfusion was used in critical patients with major bleeding and, therefore, the total amount of transfused blood/blood product was higher in these patients. Nevertheless, lower complication rates in this patient group emphasize the importance of autologous blood transfusion.
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Left ventricular assist device (LVAD) implantation via left lateral thoracotomy with outflow cannula anastomosis to the descending aorta is an alternative technique that avoids anterior mediastinal planes and requires a single incision. This study compares changes in exercise capacity following LVAD implantation with outflow cannula anastomosis to the descending aorta versus ascending aorta. Adult patients who received a continuous flow centrifugal LVAD implantation and completed both pre- and postimplantation cardiopulmonary exercise tests (CPETs) and or 6-minute walk tests (6MWT) were included. Change in CPET parameters (maximum oxygen intake: vO2 max, oxygen uptake efficiency ratio: OUES, ventilatory efficiency ratio: vE/vCO2 Slope) and 6MWT distance were compared between ascending and descending aorta anastomosis groups. Ascending and descending aorta anastomosis cohorts included 59 and 14 patients, respectively. Pre- and postimplantation CPETs were performed 63 ± 12 days before and 216 ± 17 days following implantation. The improvement in CPET parameters (vO2 max, OUES, vE/vCO2 Slope) or 6MWT distance was not significantly different between the ascending and descending aorta anastomosis groups. This study found no significant difference in the improvement of CPET parameters or 6MWT distance between LVAD implantation via thoracotomy with outflow cannula anastomosis to descending aorta and standard implantation via sternotomy with outflow cannula anastomosis to ascending aorta.