Hematopoietic Stimulation During Impella 5.5 Support to Avoid Transfusions in a Jehovah's Witness.

The population presenting with cardiogenic shock is heterogenous. Anemia is common in advanced heart failure and associated with poor outcomes. Microaxial flow pumps may cause ongoing blood trauma and worsen anemia. Treatment with recombinant erythropoietin, iron, vitamin B, and folate is recommended before cardiac surgery to reduce perioperative transfusion requirements but no data exist on the feasibility and safety during support with microaxial flow pumps. This novel strategy was born out of necessity to support a Jehovah's Witness who opposes blood transfusion but required mechanical circulatory support. We present its efficacy over the duration of 19 days of Impella 5.5 support where hemoglobin level remained stable, and platelet count significantly improved despite a brief episode of gastrointestinal bleeding. No thromboembolic complications occurred. We anticipate this strategy could help not only Jehovah's Witnesses, but also patients awaiting cardiac transplantation since transfusions stimulate development of antibodies which may preclude or postpone finding a suitable donor organ. Furthermore, it may minimize or prevent perioperative needs for transfusions for patients being bridged to durable left ventricular assist devices.

Total artificial heart implantation as a bridge to transplantation: a viable model for the future?

INTRODUCTION: Since the first total artificial heart (TAH) surgery in a human patient performed in 1969, over 1300 devices have been implanted worldwide. Patients are benefiting from increased lengths of durable support and indications have expanded beyond biventricular failure including allograft failure, severe restrictive disease, and complex congenital anomalies. Areas covered: The role of the TAH in biventricular failure, rates of successful bridge-to-transplant (BTT), and survival compared with biventricular assist devices (BiVADs) are discussed and differences between TAH and LVAD patient populations are highlighted. The device's niche role in physiologies not amenable to single ventricle support is further described. New developments such as the 50cc Syncardia, continuous flow mechanisms (BiVACOR and Cleveland Clinic CF-TAH), and a bioprosthetic model (CARMAT) are discussed. Literature review was conducted utilizing the PubMed database selecting published research, database analyses, and case reports under 'total artificial heart' relevant to the paper's aims. Expert commentary: TAH patients have high rates of successful BTT and survival on par with BiVAD-supported patients. Ongoing developments including decreased device size, continuous flow mechanisms, and use of bioprosthetic materials will ensure that the TAH will have an increasing role in advanced heart failure with increased device longevity and decreased post-implant complications.

Destination therapy with a rotary blood pump and novel power delivery.

OBJECTIVE: We tested the hypothesis that a miniaturised axial flow pump with infection-resistant power delivery could improve longevity and quality of life (QOL) in advanced heart failure patients deemed unsuitable for transplantation. METHODS: The study included all non-United States Jarvik 2000 patients (n=46), where a skull-pedestal-based power line was employed with the intention of long-term support. Patient age ranged from 29 to 80 years. Of the 46 patients, 42 were male. All were New York Heart Association (NYHA) IV predominantly with idiopathic dilated (n=22) or ischaemic (n=18) cardiomyopathy. The experience (2000-2008) included the learning curve of 10 centres. RESULTS: The internal components are imperceptible. The power/control system is user friendly, allowing excellent QOL. There has been no pump malfunction. The Kaplan-Meier survival analysis is shown. The longest event-free survival is 7.5 years. Support exceeded 3 years in five cases. The cumulative experience exceeds 50 years. Three patients were transplanted, and two pumps were replaced at 90 and 203 days. Nineteen cases are ongoing (mean: 663 days), while 22 died during support (mean survival: 402 days), of which five from non-device-related diseases. Temporary local infection occurred in three pedestals, and there has been no pump infection. Incidence of thrombo-embolic events showed wide variation between centres. CONCLUSIONS: From this learning-curve experience, both left ventricular assist device (LVAD) and power delivery are reliable and promising for destination therapy. Early mortality is similar to other studies and relates to the severity of illness. Pump infection has not occurred and prolonged event-free survival is clearly possible with expert medical management.

Análise dos resultados do uso precoce e tardio da assistência circulatória com baläo intra-aórtico (BIA) em pacientes submetidos a correçäo de cardiopatias com auxílio de circulaçäo extracorpórea / Analysis of the results of the early and late use of assist cieculation with intra-aortic balloon in patients subjected to repair of cardiopathies with extracorporeal circulation

Este estudo tem como objetivo, a análise retrospectiva do uso precoce (intra-operatório) e tardio (pós-operatório) do balao intra-aórtico. Foram estudados 130 pacientes do Texas Heart lnstitute, no período de janeiro a dezembro de 1987, sendo 103 do sexo masculino e 27 do sexo feminino; a idade média dos pacientes foi de 61,5 + 10,76 (14 a 84) anos, a média de peso foi de 75,5 ñ 16,6 (42 a 134) kg, a média de superfície corpórea de 1,87 ñ O,24 (1,O8 a 2,60)m(2) e um tempo médio de circulaçao extracorpórea de 98 (33 a 299) minutos e de pinçamento aórtico de 49 (1O a 122) minutos. O balao intra-aórtico foi usado em todos os pacientes por baixo débito cardíaco, em 4 associado a disrritmias refratárias a tratamento clínico e 2 por parada cardiorrespiratória, por períodos que variaram de 15 minutos a 256 horas. Os pacientes foram divididos em 6 grupos; Grupo I, pacientes que receberam o balao intra-aórtico no intra-operatório (precoce), Grupo II, pacientes que receberam o balao intra-aórtico no pós-operatório (tardio), Grupo III (pacientes com idade igual ou inferior a 65 anos), Grupo IV (pacientes com idade superior a 65 anos), Grupo V (pacientes com tempo de circulaçao extracorpórea de até 120 minutos) e grupo VI (pacientes com tempo de circulaçao extracorpórea superior a 120 minutos) e 2 subdivisoes nos grupos V e VI, subgrupo 1/. (pacientes com tempo de pinçamento de aorta menor ou igual a 60 minutos) e subgrupo 2/. (pacientes com tempo de pinçamento de aorta maior que 60 minutos). Dos 130 pacientes submetidos ao BIA, 81 (62.3 por cento) sobreviveram e 49 (37,7 por cento) pacientes faleceram; destes, 38 (36,2 por cento) pertenciam ao grupo I e ll (44 por cento) ao grupo II. A sobrevida foi maior no Grupo III (68,6 por cento) e menor no Grupo IV (51 por cento) com p