Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 12.443
Filtrar
2.
Medicine (Baltimore) ; 98(37): e17107, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517843

RESUMO

BACKGROUND: Percutaneous mechanical circulatory support devices (pMCSDs) are increasingly used on the assumption (but without solid proof) that their use will improve prognosis. A meta-analysis was undertaken according to the PRISMA guidelines to evaluate the benefits of pMCSDs in patients undergoing high-risk percutaneous coronary intervention (hr-PCI). METHODS: We searched PubMed, EMbase, Cochrane Library, Clinical Trial.gov, and other databases to identify eligible studies. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated for 30-day and 6-month all-cause mortality rates, reinfarction, and other adverse events using a random effect model. RESULTS: Sixteen randomized controlled trials (RCTs) were included in this study. In the pooled analysis, intra-aortic balloon pump (IABP) was not associated with a decrease in 30-day and 6-month all-cause mortality (RR 1.01 95% CI 0.61-1.66; RR 0.88 95% CI 0.66-1.17), reinfarction (RR 0.89 95% CI 0.69-1.14), stroke/transient ischemic attack (TIA) (RR 1.75 95% CI 0.47-6.42), heart failure (HF) (RR 0.54 95% CI 0.11-2.66), repeat revascularization (RR 0.73 95% CI 0.25-2.10), embolization (RR 3.00 95% CI 0.13-71.61), or arrhythmia (RR 2.81 95% CI 0.30-26.11). Compared with IABP, left ventricular assist devices (LVADs) were not associated with a decrease in 30-day and 6-month all-cause mortality (RR 0.96 95% CI 0.71-1.29; RR 1.23 95% CI 0.88-1.72), reinfarction (RR 0.98 95% CI 0.68-1.42), stroke/TIA (RR 0.45 95% CI 0.1-1.95), acute kidney injury (AKI) (RR 0.83 95% CI 0.38-1.80), or arrhythmia (RR 1.52 95% CI 0.71-3.27), but LVADs were associated with a decrease in repeat revascularization (RR 0.26 95% CI 0.08-0.83). However, LVADs significantly increased the risk of bleeding compared with IABP (RR 2.85 95% CI 1.72-4.73). CONCLUSIONS: Neither LVADs nor IABP improves short or long-term survival in hr-PCI patients. LVADs are more likely to reduce repeat revascularization after PCI, but to increase the risk of bleeding events than IABP.


Assuntos
Coração Auxiliar/normas , Balão Intra-Aórtico/normas , Intervenção Coronária Percutânea/métodos , Arritmias Cardíacas/terapia , Embolização Terapêutica/métodos , Insuficiência Cardíaca/terapia , Coração Auxiliar/estatística & dados numéricos , Humanos , Balão Intra-Aórtico/métodos , Balão Intra-Aórtico/estatística & dados numéricos , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Fatores de Risco , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
6.
Surg Clin North Am ; 99(5): 1019-1027, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446907

RESUMO

Shared decision making requires the exchange of information from the patient and the surgeon (and ideally involves the expertise of the entire multidisciplinary team) to determine the medical and/or surgical treatment that best aligns with the patient's goals and values. Should the surgical patient wish to transition to end-of-life care, the transition to comfort-focused care is within the scope of practice for surgeons. Incorporating the expertise of other health care professionals is an important consideration for whole-patient care. Integrating primary palliative care into surgical practice can help mitigate unnecessary suffering and allow a smoother transition to comfort-focused care.


Assuntos
Cuidados Paliativos , Assistência Terminal , Diretivas Antecipadas , Tomada de Decisões , Coração Auxiliar , Humanos , Obstrução Intestinal/terapia , Assistência Terminal/métodos
7.
Kardiologiia ; 59(7): 95-96, 2019 Jul 19.
Artigo em Russo | MEDLINE | ID: mdl-31322095

RESUMO

In this article we present a clinical case of a 46-year-old man, who developed ventricular fibrillation at the background of implanted left ventricular assist device (LVAD) Heart Mate II because of dilated cardiomyopathy with biventricular chronic heart failure. Ventricular fibrillation required electrical and medical defibrillation with further treatment in the intensive care unit.


Assuntos
Cardiomiopatia Dilatada , Insuficiência Cardíaca , Coração Auxiliar , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Fibrilação Ventricular
10.
World J Pediatr Congenit Heart Surg ; 10(4): 518-519, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307293

RESUMO

Progressive ventricular dysfunction is not uncommon in patients with univentricular hearts as they age. In the acute setting vasoactive support can be employed, but is not always sufficient and patients occasionally require mechanical support. We report the successful implantation and subsequent challenges of a percutaneous Abiomed Impella ventricular assist device as a rescue therapy for a 15-year old-patient with Fontan circulation and severe ventricular dysfunction after cardiac arrest.


Assuntos
Insuficiência Cardíaca/cirurgia , Coração Auxiliar , Síndrome do Coração Esquerdo Hipoplásico/complicações , Doença Aguda , Adolescente , Desenho de Equipamento , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Humanos , Síndrome do Coração Esquerdo Hipoplásico/diagnóstico , Síndrome do Coração Esquerdo Hipoplásico/cirurgia
11.
Int Heart J ; 60(4): 994-997, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31257336

RESUMO

Pump thrombosis (PT) is a serious complication after continuous-flow left ventricular assist device (LVAD) implantation. To detect PT, echocardiographic ramp test using left ventricular end-diastolic diameter (LVEDD) is known to be useful. However, this method has several limitations. In this study, we propose an alternative novel ramp test using the flow velocity of outflow graft (OG). A 46-year-old man underwent continuous-flow LVAD (HeartMate II, Abbott Laboratories, Lake Forest, IL, USA) implantation for advanced heart failure due to idiopathic dilated cardiomyopathy. About 2 years after implantation, he suffered from hemolysis and symptoms of heart failure, and PT was strongly suspected. The change in LVEDD was minimal with increase in pump speed (-0.06 cm/400 rotations per minute (rpm)), suggesting PT. The systolic to diastolic velocity (S/D) ratio of OG flow, which we proposed as a new indicator of PT, also showed minimal change (-0.07/400 rpm). His clinical symptoms improved with anticoagulation therapy, and the changing slope of the S/D ratio dramatically improved to -0.92/400 rpm. Although its consistency should be verified in many other cases, this novel method can be useful for detecting PT and evaluating its clinical course.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Insuficiência Cardíaca/terapia , Coração Auxiliar/efeitos adversos , Fluxo Sanguíneo Regional/fisiologia , Trombose/etiologia , Função Ventricular Esquerda/fisiologia , Ecocardiografia , Falha de Equipamento , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Trombose/diagnóstico , Trombose/fisiopatologia
12.
Hu Li Za Zhi ; 66(4): 87-94, 2019 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-31342505

RESUMO

Heart failure is a complicated chronic disease. Although numerous new medications are used to treat and improve the quality of life of patients with heart failure, the final treatment for terminal heart failure still relies heavily on heart transplants. However, as the number of heart donations is limited, many health institutions implant mechanical assist devices to perform heart functions temporarily. These implanted ventricular assist devices help reduce heart failure symptoms and enhance quality of life. However, driveline infection is one of the more severe complications associated with these devices. If this infection is not controlled, another heart surgery will be necessary to replace the device. Severe driveline infection may even lead to patient death. An approach to care that includes driveline wound care standardization and immobilization of the driveline has been shown to effectively decrease the incidence of driveline infections and to increase the survival rate. As Taiwan still lacks the relevant clinical care standards for implantable ventricular assist device support and driveline wound care, this study introduces the relevant Western literature and the author's clinical experience related to driveline wound management. We hope that this article serves as a useful reference for related nursing care.


Assuntos
Insuficiência Cardíaca/terapia , Coração Auxiliar , Infecções Relacionadas à Prótese/prevenção & controle , Desenho de Equipamento , Insuficiência Cardíaca/enfermagem , Coração Auxiliar/efeitos adversos , Humanos , Infecções Relacionadas à Prótese/etiologia , Qualidade de Vida , Taiwan , Fatores de Tempo
13.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 36(3): 379-385, 2019 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-31232539

RESUMO

An implantable axial blood pump was designed according to the circulation assist requirement of severe heart failure patients of China. The design point was chosen at 3 L/min flow rate with 100 mm Hg pressure rise when the blood pump can provide flow rates of 2-7 L/min. The blood pump with good hemolytic and anti-thrombogenic property at widely operating range was designed by developing a structure that including the spindly rotor impeller structure and the diffuser with splitter blades and cantilevered main blades. Numerical simulation and particle image velocimetry (PIV) experiment were conducted to analyze the hydraulic, flow fields and hemolytic performance of the blood pump. The results showed that the blood pump could provide flow rates of 2-7 L/min with pressure rise of 60.0-151.3 mm Hg when the blood pump rotating from 7 000 to 11 000 r/min. After adding the splitter blades, the separation flow at the suction surface of the diffuser has been reduced efficiently. The cantilever structure changed the blade gap from shroud to hub that reduced the tangential velocity from 6.2 m/s to 4.3-1.1 m/s in blade gap. Moreover, the maximum scalar shear stress of the blood pump was 897.3 Pa, and the averaged scalar shear stress was 37.7 Pa. The hemolysis index of the blood pump was 0.168% calculated with Heuser's hemolysis model. The PIV and simulated results showed the overall agreement of flow field distribution in diffuser region. The blood damage caused by higher shear stress would be reduced by adopting the spindle rotor impeller and diffuser with splitter blades and cantilevered main blades. The blood could flow smoothly through the axial blood pump with satisfactory hydraulics performance and without separation flow.


Assuntos
Desenho de Equipamento , Insuficiência Cardíaca/terapia , Coração Auxiliar , China , Simulação por Computador , Hemólise , Humanos , Modelos Cardiovasculares
14.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 36(3): 478-485, 2019 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-31232552

RESUMO

The rotary left ventricular assist device (LVAD) has been an effective option for end-stage heart failure. However, while clinically using the LVAD, patients are often at significant risk for ventricular collapse, called suction, mainly due to higher LVAD speeds required for adequate cardiac output. Some proposed suction detection algorithms required the external implantation of sensors, which were not reliable in long-term use due to baseline drift and short lifespan. Therefore, this study presents a new suction detection system only using the LVAD intrinsic blood pump parameter (pump speed) without using any external sensor. Three feature indices are derived from the pump speed and considered as the inputs to four different classifiers to classify the pumping states as no suction or suction. The in-silico results using a combined human circulatory system and LVAD model show that the proposed method can detect ventricular suction effectively, demonstrating that it has high classification accuracy, stability, and robustness. The proposed suction detection system could be an important part in the LVAD for detecting and avoiding suction, while at the same time making the LVAD meet the cardiac output demand for the patients. It could also provide theoretical basis and technology support for designing and optimizing the control system of the LVAD.


Assuntos
Insuficiência Cardíaca/cirurgia , Coração Auxiliar/efeitos adversos , Modelos Cardiovasculares , Sucção/efeitos adversos , Simulação por Computador , Ventrículos do Coração , Humanos
15.
Artigo em Alemão | MEDLINE | ID: mdl-31212331

RESUMO

Extracorporal membrane oxygenation (ECMO) is used to stabilize severe cardiocirculatory and/or respiratory failure in emergency situations. Left ventricular assist devices (LVAD) are used for the treatment of severe chronic heart failure. ECMO and LVAD systems are increasingly employed and provide substantial benefit for respective patients. However, the use of ECMO and LVAD systems is associated with a multifactorial coagulopathy, which is characterized by thromboembolic and hemorrhagic complications. ECMO- and LVAD-induced thromboembolic events are caused by contact activation of plasmatic coagulation and platelets at the artificial surfaces of the respective system. Shear forces inside ECMO and LVADs further contribute to prothrombotic platelet activation. To prevent thrombotic occlusion of ECMO and LVAD systems anticoagulants are routinely administered. For this purpose heparin is primarily used. This may however result in heparin-induced thrombocytopenia, which can further complicate ECMO- and LVAD-associated coagulatory dysfunction. Bleeding complications during ECMO and LVAD therapy can be related to systemic anticoagulation. Qualitative and quantitative platelet defects as well as shear force induced acquired von Willebrand disease further contribute to hemorrhagic events. In conclusion, the management of the ECMO- and LVAD-associated coagulopathy is based on the understanding of its contributing factors. Respective causes for thrombotic and/or hemorrhagic complications should be identified with coagulation assays including viscoelastic point of care tests and platelet aggregometry. Once the underlying reason for the observed coagulopathy has been identified further treatment measures should be individually tailored.


Assuntos
Transtornos da Coagulação Sanguínea , Oxigenação por Membrana Extracorpórea , Coração Auxiliar , Anticoagulantes/uso terapêutico , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/terapia , Hemorragia , Humanos
17.
Diving Hyperb Med ; 49(2): 137-140, 2019 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-31177520

RESUMO

INTRODUCTION: During a hyperbaric oxygen therapy (HBOT) session, every medical device that is used within the hyperbaric chamber is exposed to several hazards, including an increased ambient pressure and partial pressure of oxygen. In Europe, all medical devices marketed and/or sold for use in hyperbaric conditions must be tested by the manufacturer and marked 'CE' if approved. At the moment, no left ventricular assist device (LVAD) has been formally approved and CE-marked for HBOT. CASE: A 65-year-old male was referred to our Hyperbaric Centre for HBOT due to a persistent life-threating soft tissue infection of the non-removable wire connecting the external controller with the pump implanted into the left ventricle of the heart (Heartware LVAD). The aim of the intervention reported here was to safely conduct HBOT sessions with this non-CE marked medical device. After risk analysis, the decision was made to isolate the external part of the LVAD (controller and batteries) from the ambient conditions in the hyperbaric chamber by placing it in a pressure-resistant housing that was vented to the external atmosphere. The housing, a 'Hyperbaric Protective Tube' was built and tested, and the resulting operating procedures were practiced by personnel involved in the patient's care. Thirty uneventful HBOT standard sessions were conducted with subsequent clinical improvement of the soft tissue infection, resulting in an extended timeframe for awaiting heart transplantation. CONCLUSION: An isolation housing that vents into the dumping system of the hyperbaric chamber allows for the safe use of critical medical devices without prior testing for their compatibility with the hyperbaric environment.


Assuntos
Segurança de Equipamentos , Coração Auxiliar , Oxigenação Hiperbárica , Idoso , Europa (Continente) , Humanos , Masculino
18.
EuroIntervention ; 15(7): 586-593, 2019 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-31147306

RESUMO

AIMS: The haemodynamic effects of primary implantation of an intra-aortic balloon pump (IABP) versus inotropes in decompensated heart failure and low output (DHF-LO), but without an acute coronary syndrome, have not been investigated. We therefore aimed to investigate the effect of primary IABP implantation as compared to inotropes on haemodynamics in DHF-LO with no acute ischaemia. METHODS AND RESULTS: Patients (n=32) with DHF-LO despite IV diuretics were randomised to primary 50 mL IABP or inotropes (INO: enoximone or dobutamine). The primary endpoint was the improvement of organ perfusion assessed by ∆ mixed-venous oxygen saturation (SvO2) at 3 hours; secondary endpoints included ∆ cardiac power output (CPO), NT-proBNP proportional change, cumulative fluid balance and ∆ dyspnoea severity score, all at 48 hours. Data are presented as median (IQR). Patients were 60 (48-69) years old and 72% were male. Baseline SvO2 was 44 (39-53)%. ∆SvO2 was higher in the IABP group (+17 [+9; +24] vs. +5 [+2; +9]%, p<0.05). IABP patients had a higher ∆CPO, a greater relative reduction in NT-proBNP, a more negative cumulative fluid balance, and a greater reduction in dyspnoea severity score. There were no IABP-related serious adverse events (SAEs). Thirty-day mortality was 23% (IABP) vs. 44% (INO). CONCLUSIONS: Primary circulatory support by IABP showed a significant increase in improved organ perfusion assessed by SvO2.


Assuntos
Débito Cardíaco/fisiologia , Cardiotônicos/uso terapêutico , Dobutamina/uso terapêutico , Enoximona/uso terapêutico , Insuficiência Cardíaca/cirurgia , Hemodinâmica/fisiologia , Balão Intra-Aórtico/métodos , Idoso , Débito Cardíaco/efeitos dos fármacos , Feminino , Coração Auxiliar , Hemodinâmica/efeitos dos fármacos , Humanos , Balão Intra-Aórtico/efeitos adversos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
19.
Expert Rev Med Devices ; 16(8): 663-673, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31216915

RESUMO

Introduction: Right heart failure (RHF) in patients with a left ventricular assist device (LVAD) carries a poor prognosis although the treatment strategy including mechanical circulatory support for the failing right ventricle (RV) has not been well established. Areas covered: In this review, we describe an overview of RHF post-LVAD implant including natural history, prevalence, pathophysiology, outcomes, and challenges to predict RHF post-LVAD implant. Then, we focus on right ventricular assist devices (RVADs) and their clinical outcomes. Recently developed percutaneous RVADs are the major advance in this field. Finally, we discuss future perspectives to overcome limitations of the current treatment options. Expert opinion: In the absence of dedicated RVAD system RHF post-LVAD implant may have been undertreated. Now that dedicated percutaneous RVADs have emerged, surgeons are encouraged to use these new devices to improve outcomes of LVAD therapy. As experience accumulates, we should be able to establish the best possible strategy to treat early RHF post-LVAD implant. Late RHF is another form of RHF post-LVAD implant and has been underappreciated. Further research is mandatory to clarify the mechanism and risk factors. There are still unmet needs for a dedicated implantable RVAD for a subset of patients who need long-term RV support.


Assuntos
Circulação Sanguínea , Coração Auxiliar , Insuficiência Cardíaca/terapia , Ventrículos do Coração/fisiopatologia , Coração Auxiliar/efeitos adversos , Humanos , Fatores de Risco , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA