Clinical outcomes after ventricular assist device implantation in adults with complex congenital heart disease
Nishant R. ShahWilson LamFred H. RodriguezPeter ErmisLeo SimpsonO.H. FrazierWayne FranklinDhaval R. Parekh
54
Citation
13
Reference
10
Related Paper
Citation Trend
Keywords:
Artificial heart
Destination therapy
Etiology
Left Ventricular Assist Device (LVAD) for Destination Therapy (DT) is an established therapy for end stage heart failure patients who are not transplant candidates. Many DT patients requiring LVADs have had prior open heart surgery, the majority of whom had prior sternotomy. In addition, DT patients tend to be older and more likely to have more significant co-morbidities than their Bridge-To-Transplant (BTT) counterparts. As such, placement of an implantable LVAD in DT patients can be technically hazardous and potentially prone to more perioperative complications. The purpose of this report is to describe an alternative implantation approach for the implantation of the Heartmate II™ LVAD in high risk DT patients.
Destination therapy
Cardiothoracic surgery
Vascular surgery
Median sternotomy
Cite
Citations (15)
Implantable prosthetic ventricles and trileaflet valves made by vacuum forming have been developed and implant tested. All components are made from Pellethane ® . Recognizing the need for smaller as well as larger ventricles, designs with effective stroke volumes of 50, 85, 100 and 130 cc have been tested with several valve types. The pneumatically driven Utah ventricular assist device (UVAD) can be used as a total artificial heart (TAH) or ventricular assist device (VAD) by using the appropriate inflow and outflow adapters. In vitro durability testing has demonstrated ventricular lifetime beyond two years and valve lifetime to nearly one and one half years. The polymer valves have lower regurgitation than mechanical valves. Animal implantation experience includes 21 TAH implants and 16 left ventricular assist device (LVAD) implantations. TAH survival ranges from 2 to 210 days. LVAD animals have lived up to 116 days before elective termination. The animal were healthy and grew normally. The devices exhibit a “Starling's Law” response. One TAH animal survived 72 days before successful explantation followed by transplantation. At autopsy, this animal had no renal infarcts. Hematology data has demonstrated the existence of little or no intravascular hemolysis (PF Hb < 5 mg%). The “Philadelphia” version of the UVAD vacuum formed ventricles are small enough to be implanted without thrombus provoking connectors. Eight animals have received this TAH and survived up to 120 days. Vacuum forming offers a rapid and inexpensive way to produce reliable and effective total artificial hearts and valves for widespread, temporary clinical application in any size adult human.
Artificial heart
Animal model
Animal study
Cite
Citations (9)
634 Terminally ill heart failure patients awaiting heart transplantation (HT) who require mechanical circulatory assistance for survival may have right ventricular function that is too poor to permit isolated left ventricular assist device therapy. In our institution, between July 1, 1994 to December 31, 1996 we used the Cardiowest total artificial heart on such patients who eventually received a heart transplant (Group I). We compared these patients to other patients awaiting HT, who were not as ill prior to HT, who were successfully transplanted without need for any other circulatory assist device(Group II). TableConclusions: In patients fortunate enough to received eventual HT, the use of Cardiowest total artificial heart is a very effective bridge to HT, despite the high hospital charges associated with additional surgery and longer hospitalization.
Artificial heart
Bridge to transplantation
Cite
Citations (0)
Destination therapy
Single Center
Cite
Citations (1)
The total artificial heart (TAH) is a form of mechanical circulatory support in which the patient's native ventricles and valves are explanted and replaced by a pneumatically powered artificial heart. Currently, the TAH is approved for use in end-stage biventricular heart failure as a bridge to heart transplantation. However, with an increasing global burden of cardiovascular disease and congestive heart failure, the number of patients with end-stage heart failure awaiting heart transplantation now far exceeds the number of available hearts. As a result, the use of mechanical circulatory support, including the TAH and left ventricular assist device (LVAD), is growing exponentially. The LVAD is already widely used as destination therapy, and destination therapy for the TAH is under investigation. While most patients requiring mechanical circulatory support are effectively treated with LVADs, there is a subset of patients with concurrent right ventricular failure or major structural barriers to LVAD placement in whom TAH may be more appropriate. The history, indications, surgical implantation, post device management, outcomes, complications, and future direction of the TAH are discussed in this review.
Artificial heart
Destination therapy
Bridge to transplantation
Cite
Citations (50)
Destination therapy
Bridge to transplantation
Bridge (graph theory)
Artificial heart
Cite
Citations (0)
Left-ventricular assist device (LVAD) therapy is a growing mechanical circulatory support therapy used to treat patients with advanced heart failure. There is a general assumption among clinicians that patients would prefer to accept a heart to any other treatment were they eligible. However, little research has been done to clarify the nuances of patient treatment preferences for LVAD therapy versus transplantation. The objective of this study was to investigate this treatment preference assumption from patients' perspectives. In a single-site study, 15 LVAD patients, 15 LVAD candidates, 15 LVAD decliners, and 15 LVAD caregivers (n = 60) participated in structured, in-depth interviews to assess decisional processes and treatment preferences for advanced heart failure. The interview guides were consistent with the Ottawa framework on decision-making processes. All participants were identified by the LVAD coordination team and recruited consecutively between February and November 2014. The patient and candidate groups included both LVAD designations: destination therapy (n = 22), bridge-to-transplant (n = 4), as well as four participants who deferred designation pending worsening clinical status. The interviews were analyzed using qualitative description with constant comparisons, aided by ATLAS.ti. Although LVAD eligible patients generally show a preference for heart transplantation as the ideal treatment for heart failure, some patients begin to show ambivalence as they experience LVAD therapy and begin to prefer LVAD as a long-term, destination treatment. Some themes that emerged from the interviews concerning transplantation centered on the consequences of multiple major surgeries (i.e., LVAD placement followed by heart transplantation, n = 18), fears surrounding lifestyle changes of accepting a heart transplant (n = 14) and life satisfaction with an LVAD as a "new normal" (n = 18). Findings suggest that experience with an LVAD can sometimes cause ambivalence about transplant with some patients preferring LVAD as destination even when transplant is an option. We provide clinical and programmatic implications of this, concluding with practical recommendations for how to fully address patients' goals of treatment as their health and situation changes over time.
Destination therapy
Bridge to transplantation
Artificial heart
Cite
Citations (9)
The left ventricular assist device originated as a means to provide temporary circulatory support for patients suffering from end-stage heart failure. The device was originally intended to serve as a bridge to cardiac transplantation. Increasingly, however, the left ventricular assist device is being utilized as a destination therapy for those patients who are not candidates for heart transplantation. It is this utilization as a destination therapy that raises additional significant ethical concern related to the risks and benefits of the devices, factors influencing quality of life, and consequences pertaining to end-of-life care.
Destination therapy
Bridge to transplantation
Bridge (graph theory)
Cite
Citations (2)
Introduction: For the patients awaiting cardiac transplantation, mechanical circulatory support has been widely utilized in the form of left ventricular assist device or total artificial heart. Both total artificial heart and left ventricular assist device have been approved for the use as a bridge to transplantation therapy; however only left ventricular assist device has been approved for use as the destination therapy. The purpose of this review is to establish, using this literature, the possibility for the artificial heart transplant to be used as destination therapy besides highlighting the recent developments in this area of research in order to narrate the future of artificial heart transplantation. You can submit your Manuscripts at: https://symbiosisonlinepublishing.com/submitManuscript.php
Artificial heart
Destination therapy
Bridge to transplantation
Bridge (graph theory)
Cite
Citations (0)
Abstract Aims The need for the left ventricular assist devices (LVAD) in patients with end‐stage heart failure is well established, but prior to 2011, this was not available to patients in Kazakhstan. We describe the development of the sole LVAD programme in the context of a nascent heart transplantation programme and clinical outcomes for the first three years. Methods and results From November 2011 to November 2014, 146 patients underwent implantation of 152 VADs (approximately 50 devices implanted per year). We retrospectively analyzed data from 135 LVAD patients who received HeartMate II ( n = 95) or HeartWare ( n = 40) devices. In 75 patients LVAD was used as a bridge‐to‐transplantation and in 60 patients as destination therapy, but only 3 of 135 LVAD patients received heart transplant. Forty‐three patients of the LVAD cohort had died by the end of the follow‐up period. The mean time on LVAD was 466 ± 330 days (range 5–1200 days). Kaplan–Meier survival estimates for patients who continued on LVAD support were 93% after 1 month, 86% after 6 months and 77% after 12 months. The most common complications within the first 30 days after implant included right ventricular failure ( n = 20, 1.85 events/patient‐year), renal failure ( n = 19, 1.76 events/patient‐year) and bleeding ( n = 33, 3.0 events/patient‐year). Beyond 30 days adverse events included driveline infections ( n = 46, 0.56 events/patient‐year) and stroke ( n = 33, 0.21 events/patient‐year). Conclusions LVADs are an important therapeutic alternative to heart transplantation in the context of a developing heart transplant programme with outcomes that are comparable to those reported by other centres.
Destination therapy
Stroke
Artificial heart
Cite
Citations (18)