Telecardiographic measurements for device migration: A useful tool for follow-up.

OBJECTIVE: Pump thrombosis in left ventricular assist device (LVAD) patients is an important cause of mortality and morbidity. Inflow cannula migration is a predisposing factor for pump thrombosis. Telecardiographic measurements can be used to follow up apical cannula deviation. In this study, we aimed to evaluate the migration of the inflow cannulas in patients with LVADs using angle measurements on telecardiograms. METHODS: Twenty-three patients who were implanted left ventricular assist devices in our clinic between February 2013 and April 2016 were included in our study. During the first year of follow-up, changes in angle measurements on postoperative 1st, 3rd, 6th, and 12th month telecardiograms were compared against the incidence of device thrombus and serum Lactate Dehydrogenase (LDH) levels. RESULTS: Patients who were diagnosed with device thrombosis had more change in inflow cannula angles than patients without device thrombus (p<0.05 at 6th and 12th months). Patients with higher LDH values had more parallel angular changes at all intervals, and the change in angle was statistically significant at 3rd, 6th and 12th months (p<0.05). CONCLUSION: This study shows that it is possible to track the migration of inflow cannulas in patients with left ventricular heart failure using telecardiograms. The correlation between angle change and LDH levels and embolic events may suggest that telecardiographic follow up of angles may be a useful tool for ventricular assist devices teams for early detection of thrombus.

Usefulness of right ventricular contraction pressure index to predict short-term mortality and right heart failure in patients who underwent continuous-flow left ventricular assist device implantation.

BACKGROUND: Right ventricular stroke work index is a useful but invasively measured parameter that can be used to predict right heart failure following continuous-flow left ventricular assist device implantation. Right ventricular contraction pressure index is a novel parameter that was developed to measure right ventricular stroke work index with echocardiography. We aimed to investigate the clinical usefulness of right ventricular contraction pressure index to predict short-term mortality and right heart failure in patients who underwent continuous-flow left ventricular assist device implantation. METHODS: A total of 49 patients who participated in institutional advanced heart failure registry and underwent continuous-flow left ventricular assist device implantation with a bridge-to-candidacy indication were analyzed retrospectively. Right ventricular contraction pressure index was calculated using offline measurements. Demographic, clinical and outcome data were obtained from the registry data. Patients were grouped according to right ventricular contraction pressure index quartiles. RESULTS: Patients within the lowest right ventricular contraction pressure index quartile had a trend toward higher short-term mortality (46.2%, p = 0.056) and combined short-term mortality and definitive right heart failure (53.8%, p = 0.054) at 15th day postoperatively. Similarly, short-term survival or survival free of definite right heart failure were significantly lower in the lowest right ventricular contraction pressure index quartile (log-rank p = 0.045 and log-rank p = 0.03, respectively). In a proportional hazards model that included echocardiographic parameters, right ventricular contraction pressure index was an independent predictor for short-term mortality (odds ratio: 6.777, 95% confidence interval: 1.118-41.098, p = 0.037), but not for combined short-term mortality and definite right heart failure. No such associations were found for long-term mortality. Right ventricular contraction pressure index had a statistically significant correlation with invasively measured pulmonary capillary wedge pressure, pulmonary vascular resistance, mean pulmonary pressure, and right ventricular stroke work index. CONCLUSION: Right ventricular contraction pressure index was found as a useful parameter for determining short-term postoperative mortality in patients undergoing continuous-flow left ventricular assist device implantation.

Stent versus bypass: The reasons and risk factors for early readmission to hospital after myocardial revascularization.

OBJECTIVE: Though 30-day rates of readmission for coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) remain high, readmission rates and associated risk factors have not been well examined. The purpose of the present study was to determine the risk factors for and rates of readmission and to compare two revascularization methods on that basis. METHODS: The study included 2664 consecutive patients who underwent coronary revascularization either with CABG surgery or PCI. The study was performed retrospectively and a wide variety of risk factors related to readmission were selected for analysis, including demographic data, preoperative risk factors and postoperative complications. RESULTS: From the CABG group (Group 1, n=1103), 18.3% were readmitted, as were 15.2% of the PCI group (Group 2, n=1561). In multivariate analysis, age, gender, left ventricular ejection fraction (LVEF), chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), length of stay (>10 days), body mass index (BMI), and creatinine level on admission were associated with early readmission for group 1 (Table 3). In group 2, age, gender, LVEF, DM, length of stay (>10 days), and creatinine level on admission were associated with early readmission. CONCLUSION: When two methods of revascularization were compared, rates of readmission were found to be similar. Patients with cited risk factors are prone to readmission in the first 30 days, so extra precautions should be taken at discharge. Neither method can be concluded to be superior with regard to readmission rates.