Gender differences in psychosocial and clinical characteristics in the European Registry for Patients with Mechanical Circulatory Support
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Not much is known about psychosocial characteristics of men and women receiving continuous flow left ventricular assist devices (CF LVAD).To investigate gender differences in clinical and psychosocial (demographic, behavioral, psychological) characteristics in CF LVAD recipients.We analyzed European Registry for Patients with Mechanical Circulatory Support (EUROMACS) data (N=2395, 16.8% women; 2011 to 2017) and compared pre-implant characteristics in men and women intended for bridge-to-transplant (BTT) or destination therapy (DT).Women were underrepresented [DT (n=61): 13.4%; BTT (n=341): 17.6%]. They were more likely to be divorced/separated, widowed, in unstable clinical condition, and non-working (DT only), but less likely to be smokers, to have ischemic cardiomyopathy or diabetes, and younger (BTT only) than men. Missing data were abundant, especially those that reflect psychological characteristics (>87%).Gender differences were noted, some specific to device strategy. Improved collection of psychosocial characteristics is warranted to elucidate their relationship to future prognosis.Keywords:
Destination therapy
Bridge to transplantation
Destination therapy
Pulsatile flow
Pulmonary wedge pressure
Bridge to transplantation
Artificial heart
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Destination therapy
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Left ventricular mechanical assist device (LVAD) support is well established as a bridge to transplantation and as an alternative to transplantation in patients with end-stage heart failure. There are currently various LVAD systems available based on different types of pump technology. We present the VentrAssist LVAD, a centrifugal pump, and focus on a surgical implantation technique that may help reduce the complications typically associated with VAD surgery.412 patients underwent VentrAssist LVAD implantation between June 2003 and January 2009 worldwide. The overall rate of success was 81 % (i.e., ongoing, HTX, or recovery). Interestingly hemolysis is greatly reduced with this intracorporeal centrifugal LVAD compared to other VAD systems with other pump designs. Our surgical implantation technique and strategy may contribute to reducing complications.The VentrAssist is a powerful and effective LVAD; its use can considerably reduce hemolysis. Long-term follow-up is necessary to determine whether the VentrAssist is appropriate as a bridge to transplant as well as feasible for long-term application.
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The Jarvik-2000 is a non-pulsatile axial-flow left ventricular assist device (LVAD) that is largely used in patients who present in end-stage heart failure, as a bridge to transplant support or destination therapy. From its first utilization, several implantation techniques have been elaborated, starting from a median sternotomy with cardiopulmonary bypass (CPB) support and moving towards a minimally invasive access with an off-pump strategy. Here we present the favored surgical technique used in our department to implant the Jarvik-2000, in a step-by-step fashion.
Pulsatile flow
Destination therapy
Bridge to transplantation
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Artificial heart
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Destination therapy
Bridge to transplantation
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Destination therapy
Bridge to transplantation
Community hospital
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Each year, thousands of cardiac patients await healthy donor hearts for transplantation. Due to the current shortage of donor hearts (approximately 2300 per year), these patients often require supplemental circulatory support until a transplant becomes available. This supplemental support is often provided by a mechanical heart pump or left ventricular assist device (LVAD). This article explores one type of LVAD, specifically the design and development of axial flow ventricular assist devices (VAD). We discuss the design details, and experimental or clinical experience with the following axial flow support systems: Hemopump, MicroMed DeBakey VAD, Jarvik 2000, HeartMate II, Streamliner, Impella, Berlin INCOR I, Valvo pump, and IVAP. All of these devices demonstrate promise in providing bridge-to-transplant and ultimately destination therapy for adult cardiac failure patients.
Impella
Bridge to transplantation
Economic shortage
Destination therapy
Axial-flow pump
Artificial heart
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Destination therapy
Bridge to transplantation
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Artificial heart
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Introduction. Implantation of the new-generation left ventricular assist device (LVAD) is an efficient therapeutic option as a bridge to transplantation in adults, as well as in children and adolescents with small body surface. The aim of this work was to present a case of a successful surgical treatment of terminal heart failure in a male adolescent who had an LVAD implanted as a bridge to heart transplantation. Case outline. The patient, a 17-year-old male, was admitted with the end-stage heart failure due to the dilated cardiomyopathy and implanted LVAD. Fourteen months after LVAD implantation, a successful ?second stage? surgical procedure was performed ? orthotopic heart transplantation preceded by the LVAD explantation. Conclusion. Long-term mechanical circulatory support is an effective and safe method in treatment of the end-stage heart failure as a bridge to transplantation in the adolescent period.
Bridge to transplantation
Destination therapy
Dilated Cardiomyopathy
Artificial heart
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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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