Right ventricular failure after orthotopic heart transplantation is associated with significant mortality and morbidity. We report the use of a paracardiac microaxial pump, the Impella RD, as a bri...
Background Short-term mechanical circulatory support may be lifesaving in patients with right ventricular (RV) failure related to post-cardiotomy cardiogenic shock (PCCS), cardiac transplantation (CTx), and long-term therapy with a left ventricular assist device (LVAD). This study evaluates our clinical experience using the CentriMag (Levitronix LLC, Waltham, Mass) system for temporary mechanical RV support. Methods A retrospective review was performed of 29 patients (mean age, 57 ± 14 years) in...
A number of techniques have been proposed for circulatory support during high-risk percutaneous coronary interventions (PCI), but no single approach has achieved wide acceptance so far. We report on a patient with severe left ventricular (LV) impairment who underwent a PCI with the use of a new left ventricular assist device, the Impella Recover LP 2.5 system. The effects on global cardiac output were determined by thermodilution (TD) and LV pressure-volume loops obtained by conductance catheter...
#1Nader Moazami(WashU: Washington University in St. Louis)H-Index: 52
#2Michael K. Pasque(WashU: Washington University in St. Louis)H-Index: 43
Last. Ralph J. Damiano(WashU: Washington University in St. Louis)H-Index: 65
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Abstract Background Patients with acute right ventricular (RV) failure after cardiotomy have a poor prognosis. We evaluated the surgical and long-term outcomes of patients with isolated RV failure that required right ventricular assist device (RVAD) support. Methods Between 1991 and 2002, a total of 30 patients received RVAD support for isolated RV dysfunction. We evaluated survival, duration of mechanical support, post-RVAD hemodynamics, and RV function. Results Right ventricular failure develo...
BACKGROUND: We planned a study to assess the safety, feasibility, and efficacy of the Impella micro-axial blood pump in patients with cardiogenic shock. METHODS: From January 2001 to September 2002 inclusive, 16 patients in cardiogenic shock (maximal inotropic support and with IABP in 11 cases) underwent left ventricle unloading with the Impella pump. 6 were placed via the femoral artery (patients in the coronary care unit) and 10 directly through the aorta (postcardiotomy heart failure). In thr...
Right ventricular support by mechanical devices for postcardiotomy right heart failure is still associated with a high mortality. We report on the first use of a new paracardiac microaxial blood pump for postcardiotomy right heart failure in two patients undergoing emergency coronary artery bypass grafting (the first patient for a myocardial infarction complicated by a left ventricular wall rupture, the second patient for a dissection of the right coronary artery after an interventional procedur...
Abstract Avoidance of the clinical syndrome of acute right-sided heart failure after heart transplantation is, unfortunately, not possible. Clinical experience and the literature certainly suggest that a significant factor in the successful management of right ventricular (RV) failure is recipient selection. Moreover, threshold hemodynamic values beyond which RV failure is certain to occur and heart transplantation is contraindicated do not exist. Nor are there values below which RV failure is a...
In this last report of the Registry’s current administration, it is appropriate to review the changes and growth of the Registry during our 7-year stewardship. The total number of thoracic transplant recipients listed in the Registry has grown from 35,972 to more than 73,000 (see Table I). In addition to the increase in sheer volume of data, the breadth and sophistication of the analyses increased, from descriptive and univariate survival analyses to complex multivariate, risk-stratified data th...
Abstract Background . Mechanical circulatory assist industries have developed ventricular assist devices (VAD) for short-, intermediate-, and long-term use. The purpose of this report is to describe the progress made with the ABIOMED Biventricular System (BVS) 5000 (ABIOMED, Inc, Danvers, MA) short-term VAD. Methods . From June 1994 through August 2000, all cardiogenic shock patients who required short-term mechanical assist were supported with the ABIOMED BVS 5000. Insertion criteria included a...
Abstract Background . After open heart operations about 1% of patients still need temporary circulatory support for severe cardiac failure, and over half of those patients die during or after the support. This study assessed the efficacy of the current strategy of circulatory support. Methods . We assessed clinical outcome of 64 consecutive patients (1.5% of pump cases) who had temporary circulatory support associated with perioperative variables. The results were analyzed by logistic regression...
Heart transplant can be considered as the “gold standard” treatment for end-stage heart failure, with nearly 5.7 million adults in the United States carrying a diagnosis of heart failure. According...
: Management of the cardiac transplant recipient includes careful titration of inotropes and vasopressors. Recipient pulmonary hypertension and ventilatory status must be optimized to prevent allograft right ventricular failure. Vasoplegia, coagulopathy, arrhythmias, and renal dysfunction also require careful management to achieve an optimal outcome. Primary graft dysfunction (PGD) can be an ominous problem after cardiac transplantation. Although mild degrees of PGD may be managed medically, mec...
Last. Komal Nadeem(UM: University of Malaya)H-Index: 1
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Abstract While left ventricular assist devices (LVADs) are common treatment for patients with heart failure, a sizeable portion of LVAD recipients demonstrate clinically significant postoperative right ventricular failure and potentially require a biventricular assist device (BiVAD). This chapter presents a summary of BiVAD requirements and then reviews several devices that have been used clinically. The majority of these devices are first-generation, pulsatile, paracorporeal systems that are la...
Second-generation ventricular assist devices (VADs) emerged after the first-generation, which had proven that mechanical assistance of the ventricular function is a promising therapy. However, the technological limitations of first-generation devices increased the need for more reliable mechanical circulatory support. This inspired clinicians, scientists, and engineers to evaluate the rotary pump principle. These so-called second-generation VADs were used as extracorporeal, paracorporeal, less i...
Mechanical circulatory support devices are the mainstay of treatment for severe cardiogenic shock refractory to pharmacologic therapy. Their evolution over the past few decades has been remarkable with a common theme of developing reliable, less bulky and more easily percutaneously implantable devices. The goal of this article is to review existing devices and advances in technology and provide insight into direction of further research and evolution of mechanical circulatory support devices for...
Abstract Heart failure is a growing epidemic, with more patients living longer and suffering from this disease. There is a growing segment of patients who have persistent symptoms despite pharmacologic therapy. In an era when transplants are rare, the need for devices and interventions that can assist ventricular function is paramount. This review goes through the devices used in heart failure, including left ventricular reconstruction, aortic counterpulsation, short-term mechanical circulatory ...
Critically ill patients at extremes of physiology may benefit from mechanical support for heart failure and intensive care practitioners should be knowledgeable about these options. In this article we will discuss the mechanical support for critically ill patients in heart failure. Referral to a specialist centre should be considered early for maximal patient benefit.
Cardiogenic shock is a serious condition that still has high mortality rates, despite the improvements with early revascularisation. In the most severe cases mechanical support is used to reverse shock and preserve other organ functions. Historically, intraaortic balloon pump counterpulsation was the first device that was used, later on followed by ECLS and ventricular assist devices. In this chapter we describe the outcomes of percutaneous mechanical circulatory support in cardiogenic shock and...
Partial mechanical support devices are capable of partially unloading only one ventricle, often the systemic one, in the setting of acute circulatory failure. They are rarely used in the pediatric population, as the mode of circulatory failure in patients with congenital heart disease often involves biventricular or a predominantly right ventricular component. The devices include intra-aortic balloon pumping, Impella, TandemHeart, and CentriMag. They are rarely used as a bridge-to-recovery, but ...