Intracorporeal Biventricular Assist Device Therapy in an 8-Year-Old Child
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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.
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The objective of this study is to review and analyze readmission data for patients who received a continuous flow left ventricular assist device (LVAD).A retrospective review of 88 patients implanted with a continuous-flow LVAD between June 2006 and June 2014 was performed. Reason for readmission, frequency, length of stay, and procedures performed during each readmission were recorded. All patients were followed in our LVAD clinic and all readmissions were reported to our program.Sixty-seven patients (76%) were discharged following their hospitalization for LVAD implant. In these patients, indication for LVAD support consisted of bridge to transplant (78%) and destination therapy (22%). Total device support time was 30,482 days, with an average support time of 455 ± 376 days. Forty-two patients (63%) were readmitted at least once, with an average length of readmission stay of nine days (median = 6). There were 129 readmissions totaling 1264 hospital days. The main reason for readmission was infection (17%). Despite this relatively high readmission rate, patients spent 86% of their time outside the hospital.Although common, LVAD readmissions can be appropriately managed with patients spending the majority of their support time at home. doi: 10.1111/jocs.12744 (J Card Surg 2016;31:361-364).
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The Successful Implantation of Continuous-Flow Left Ventricular Assist Device as a Destination Therapy in Korea: Echocardiographic AssessmentLeft ventricular assist device (LVAD) is a good treatment option for the patients ineligible for cardiac transplantation.Several studies have demonstrated that a ventricular assist device improves the quality of life and prognosis of the patients with end-stage heart failure.A 75-yr-old man debilitated with New York Heart Association (NYHA) functional class III-IV due to severe left ventricular systolic dysfunction received LVAD implantation as a destination therapy.The patient was discharged with improved functional status (NYHA functional class II) after appropriate cardiac rehabilitation and education about how to manage the device and potential emergency situations.This is the first case of successful continuous-flow LVAD implantation as a destination therapy in Korea.
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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.
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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.
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Objective: Continuous-flow left ventricular assist devices (CF-LVAD) are now allowing for years of safe circulatory support with enhanced quality of life. Our aim was to identify positive predicators for a successful longtime VAD therapy.
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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.
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