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Ventricular Assist Device Therapy in Heart Failure

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (30 August 2020) | Viewed by 9686

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Special Issue Editor

Dr. Teruhiko Imamura

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Guest Editor

Second Department of Internal Medicine, University of Toyama, Toyama 9300194, Japan
Interests: heart failure; heart transplantation; cardiology; cardiothoracic surgery
Special Issues, Collections and Topics in MDPI journals

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Dear Colleagues,

Despite advancements in heart-failure-specific therapies, both short- and long-term survivals in patients with advanced heart failure remain low. The introduction of durable mechanical circulatory support in the form of left ventricular assist devices has dramatically improved survival and quality of life for this vulnerable patient population. Owing to an improvement in the technology of LVADs, including the latest HeartMate 3 pump, survival rates are improving to a level comparable to that of heart transplantation.

Nevertheless, there are several unique device-specific complications following implantation that remain problematic and unsolved, including bleeding, stroke, aortic insufficiency, and device thrombosis. Fuerthermore, several less invasive percutaneous left ventricular assistance device systems, including Impella, have recently been developed.

The purpose of this Special Issue is to discuss how to manage the above-described or any other unkown unsolved comorbidities during left ventricular assistance device supports.

Dr. Teruhiko Imamura
Guest Editor

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Keywords

Advanced heart failure
Mechanical circulatory support
Ventricular assist device
Bleeding
Stroke
Hemocompatibility
Impella
Percutaneous
Hemodynamics

Published Papers (4 papers)

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Research

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10 pages, 319 KiB

Open AccessArticle

The Impact of Obesity on Left Ventricular Assist Device Outcomes

by Konstantin Zhigalov, Michel Pompeu Barros Oliveira Sá, Arian Arjomandi Rad, Robert Vardanyan, Lukas Goerdt, Thomas Chrosch, Alina Zubarevich, Daniel Wendt, Nikolaus Pizanis, Achim Koch, Markus Kamler, Rafal Berger, Bastian Schmack, Arjang Ruhparwar, Aron-Frederik Popov and Alexander Weymann

Medicina 2020, 56(11), 556; https://doi.org/10.3390/medicina56110556 - 23 Oct 2020

Cited by 7 | Viewed by 2085

Abstract

Background and Objectives: The understanding of high body mass index (BMI) and outcomes after Left Ventricular Assist Device (LVAD) implantation continues to evolve and the relationship has not been established yet. In this study, we investigated the effects of obesity (BMI > 30 kg/m²) on post–LVAD implantation outcomes. HeartWare LVAD and Heart Mate III LVAD were implanted. The primary outcome that was measured was mortality (in-hospital and on follow-up). The secondary outcomes that were measured were major adverse events. Materials and Methods: At our institution, the West German Heart and Vascular Center (Essen, Germany), from August 2010 to January 2020, a total of 210 patients received a long-term LVAD. Patients were stratified according to BMI ≥ 30 kg/m² representing the obesity threshold. The first group (n = 162) had an average BMI of 24.2 kg/m² (±2.9), and the second group (n = 48) had an average BMI of 33.9 kg/m² (±3.2). Baseline demographics were analysed alongside comorbidities per group. Results: Overall mortality was not significantly different between the obese group (51.1% n = 24) and the nonobese group (55.2%, n = 85) (p = 0.619). The difference between the mean duration of survival of patients who expired after hospital discharge was insignificant (2.1 years ± 1.6, group 1; 2.6 years ± 1.5, group 2; p = 0.29). In-hospital mortality was unvaried between the two groups: group 1: n = 34 (44% out of overall group 1 deaths); group 2: n = 11 (45.8% out of overall group 2 deaths) (p > 0.05). Postoperative complications were unvaried between the obese and the non-obese group (all with p > 0.05). However, a significant difference was found with regards to follow-up neurological complications (18.5% vs. 37.8%, p = 0.01) and LVAD thrombosis (14.7% vs. 33.3%, p = 0.01), as both were higher in the obese population. Conclusion: Obesity does not form a barrier for LVAD implantation in terms of mortality (in-hospital and on follow up). However, a significantly higher incidence of follow-up LVAD thrombosis and neurological complications has been found in the obese group of patients. Full article

(This article belongs to the Special Issue Ventricular Assist Device Therapy in Heart Failure)

9 pages, 640 KiB

Open AccessArticle

Is it Safe for Patients with Left Ventricular Assist Devices to Undergo Non-Cardiac Surgery?

by Rafal Berger, Attila Nemeth, Christoph Salewski, Rodrigo Sandoval Boburg, Metesh Acharya, Alexander Weymann, Konstantin Zhigalov, Bastian Schmack, Michel Pompeu B. O. Sá, Christian Schlensak and Aron-Frederik Popov

Medicina 2020, 56(9), 424; https://doi.org/10.3390/medicina56090424 - 23 Aug 2020

Cited by 1 | Viewed by 1793

Abstract

Background and Objectives: Since the first use of ventricular assist devices (VADs) as bridge to recovery and bridge to cardiac transplantation in the early 1990s, significant technological advances have transformed VAD implantation into a routine destination therapy. With improved survival, many patients present for cardiac surgery for conditions not directly related to their permanent mechanical circulatory support. The aim of this study was to analyze the indications and outcomes of non-cardiac surgeries (NCSs) of left ventricular assist device (LVAD) patients in tertiary center. Material and Methods: We present a single-center experience after 151 LVAD implantations in 138 consecutive patients between 2012–2019 who had to undergo NCS during a follow-up period of 37 +/− 23.4 months on left ventricular assist device (LVAD). Results: A total of 105 procedures was performed in 63 LVAD recipients, resulting in peri-operative mortality of 3.8%. Twenty-five (39.7%) of patients underwent multiple surgeries. We found no significant difference in cumulative survival associated with the performed surgical interventions (p = 0.469). Conclusion: We demonstrated good overall clinical outcomes in LVAD patients undergoing NCS. With acceptable peri-operative mortality, NCS can be safely performed in LVAD patients on long-term support. Full article

(This article belongs to the Special Issue Ventricular Assist Device Therapy in Heart Failure)

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11 pages, 1628 KiB

Open AccessArticle

Hemocompatibility-related Adverse Events Following HeartMate II Left Ventricular Assist Device Implantation between Japan and United States

by Teruhiko Imamura, Minoru Ono, Koichiro Kinugawa, Norihide Fukushima, Akira Shiose, Yoshiro Matsui, Kenji Yamazaki, Yoshikatsu Saiki, Akihiko Usui, Hiroshi Niinami, Goro Matsumiya, Hirokuni Arai, Yoshiki Sawa and Nir Uriel

Medicina 2020, 56(3), 126; https://doi.org/10.3390/medicina56030126 - 13 Mar 2020

Cited by 4 | Viewed by 1848

Abstract

Background: Left ventricular assist device (LVAD) therapy has improved the clinical outcomes in advanced heart failure patients, however, this may differ between countries. We aimed to compare outcomes between Japanese and US LVAD cohorts. Methods: For 416 consecutive LVAD patients who received HeartMate II LVAD implantation and completed a one-year follow-up, age-matched Japanese patients (the Japanese registry for mechanically assisted circulatory support (J-MACS) group) and the US patients were compared for their clinical outcomes. Results: 154 J-MACS patients and 77 US patients were compared. Survival, free from hemocompatibility-related adverse events (HRAEs) in the J-MACS was statistically comparable with the US (75% vs. 63%, p = 0.79). J-MACS had more disabling strokes than the US (0.221 vs. 0.052/patient-year, p = 0.005), whereas there was less nonsurgical bleeding (0.045 vs. 0.117/patient-year, p = 0.024). The net hemocompatibility score was statistically comparable between the groups (1.54 vs. 1.19 points/patient, p = 0.99). Post-LVAD prothrombin time with international normalized ratio (INR) <1.5 (odds ratio 4.07) was a risk factor for HRAEs in J-MACS, whereas INR >3.0 (odds ratio 5.71) was a risk factor in the US (p < 0.05 for both). Conclusion: In the age-matched cohorts, the J-MACS group experienced more strokes, while the US group had more bleedings. “Tailor-made” therapeutic strategy might be required for each country, given the unique variation of HRAE incidence among each country. Full article

(This article belongs to the Special Issue Ventricular Assist Device Therapy in Heart Failure)

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Review

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14 pages, 2380 KiB

Open AccessReview

Implication of Hemodynamic Assessment during Durable Left Ventricular Assist Device Support

by Teruhiko Imamura and Nikhil Narang

Medicina 2020, 56(8), 413; https://doi.org/10.3390/medicina56080413 - 15 Aug 2020

Cited by 1 | Viewed by 3466

Abstract

Durable left ventricular assist device therapy has improved survival in patients with advanced heart failure refractory to conventional medical therapy, although the readmission rates due to device-related comorbidities remain high. Left ventricular assist devices are designed to support a failing left ventricle through relief of congestion and improvement of cardiac output. However, many patients still have abnormal hemodynamics even though they may appear to be clinically stable. Furthermore, such abnormal hemodynamics are associated with an increased risk of future adverse events including recurrent heart failure, gastrointestinal bleeding, stroke, and pump thrombosis. Correction of residual hemodynamic derangements post-implantation may be a target in improving longitudinal clinical outcomes during left ventricular assist device support. Automatic and timely device speed adjustments considering a patients’ hemodynamic status (i.e., with a smart pump) are potential improvements in forthcoming devices. Full article

(This article belongs to the Special Issue Ventricular Assist Device Therapy in Heart Failure)

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