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LVAD Implantation (lvad + implantation)
Selected AbstractsIncreased Incidence of Gastrointestinal Bleeding Following Implantation of the HeartMate II LVADJOURNAL OF CARDIAC SURGERY, Issue 3 2010David R. Stern M.D. To avoid device-related thromboembolic complications, antiplatelet, and anticoagulation therapy are routinely administered. A worrisome frequency of gastrointestinal (GI) bleeding events has been observed. Methods: A retrospective review of all 33 patients undergoing long-term LVAD implantation between June 1, 2006 and July 31, 2008 at our institution for any indication was conducted. Anticoagulation consisted of heparin (intravenous or subcutaneous) followed by transition to Coumadin therapy to a target INR of two to three. Antiplatelet therapy consisted of low-dose aspirin and dipyridamole. Results: Twenty patients received the HMII and 13 patients received other devices. Eight (40%) HMII recipients suffered at least one episode of GI bleeding while no GI bleeding occurred in recipients of other devices (p = 0.012). Of 17 total bleeding episodes, no definitive source could be identified in 11 instances (65%). Conclusions: Although definitive source identification remains elusive, we believe that the majority of bleeding arises in the small bowel, possibly due to angiodysplasias, similar to the pathophysiology encountered in patients with aortic stenosis and GI bleeding. As we move toward wider use of the HMII and other axial continuous-flow devices in both bridge-to-transplant patients and for destination therapy, more studies will be necessary to understand the mechanisms of this obscure GI bleeding and develop treatment strategies to minimize its development.,(J Card Surg 2010;25:352-356) [source] Explantation of INCOR Left Ventricular Assist Device After Myocardial RecoveryJOURNAL OF CARDIAC SURGERY, Issue 6 2008Ph.D., Takeshi Komoda M.D. We describe improved surgical techniques for INCOR LVAD explantation. Methods: The outcome of INCOR LVAD implantation at our center and the operative techniques of device explantation were studied. The patients weaned from the device were followed up. Results: Out of 121 patients supported by the device, five (4.1 %) were weaned from the device, whereas 34 patients (28.1 %) underwent heart transplantation. In explantation surgery, the inflow cannula was removed (one case) or remained in the left ventricle after occlusion with an inflow cannula plug, with transection of the inflow cannula at its curve (two cases) or without transection (two cases). When the inflow cannula was occluded without the support of cardiopulmonary bypass (two cases), operative time (180 min and 210 min) was shorter than that with other explantation procedures. After mean follow-up of 2.4 years (range two months,four years) after device explantation, all five patients are alive, have not required heart transplantation and are in New York Heart Association class I (one case) or class II (four cases). After weaning from the device, no cerebrovascular complication was observed in any of the five patients. Conclusions: There is a possibility of weaning after INCOR implantation and surgical techniques for the removal of the INCOR LVAD should be further developed. [source] Human Clinical Fitting Study of the DexAide Right Ventricular Assist DeviceARTIFICIAL ORGANS, Issue 7 2009Yoshio Ootaki Abstract The DexAide right ventricular assist device (RVAD) has been developed as an implantable RVAD. The purpose of this study was to determine the final design and optimal anatomical placement of the DexAide RVAD when implanted simultaneously with either of two commercially available left ventricular assist devices (LVADs) in patients. A mock-up DexAide RVAD was used to assess configuration with each of two types of commercially available LVADs at the time of LVAD implantation in three human clinical cases. The pump body of the DexAide RVAD was placed either in the preperitoneal space or in the right thoracic cavity. The DexAide RVAD placed into the right thoracic cavity is suitable for use with the Novacor or HeartMate II LVADs. The results of this study will guide the finalization of the inflow cannula and optimal placement of the DexAide RVAD for human clinical trials. [source] Plasma Exchange Before Surgery for Left Ventricular Assist Device ImplantationARTIFICIAL ORGANS, Issue 6 2008Rajko Radovancevic Abstract:, Left ventricular assist device (LVAD) implantation in end-stage heart failure patients is frequently associated with hemorrhagic complications requiring reoperation. The preoperative coagulopathic profile includes prolonged prothrombin time (PT), partial thromboplastin time (PTT), and bleeding time; platelet dysfunction; decreased coagulation factor activity; and increased inflammatory markers. We compare outcomes in LVAD patients treated with preoperative plasma exchange with concurrent, nonrandomized control patients. We reviewed data from 68 consecutive elective patients who received LVADs at our institution. Thirty-five received LVADs after preoperative plasma exchange (replacement of one plasma volume of fresh frozen plasma), and 33 received LVADs without plasma exchange. Groups were comparable in age, sex, body weight, New York Heart Association class, intra-aortic balloon pump insertion, cardiac index, pulmonary capillary wedge pressure, creatinine, total bilirubin, hemoglobin levels, PT, international normalized ratio, PTT, and platelet count. Early mortality was lower in the plasma exchange group (0% [0/35] vs. 18% [6/33], P = 0.026), and postoperative chest tube drainage decreased by 33% (P = not significant). Blood transfusion requirements were similar.Perioperative mortality decreased in patients treated with plasma exchange before LVAD implantation. [source] |