Search Results (22)

Background: Pediatric heart transplantation (HTx) is the standard therapy for end-stage heart failure in children, and the use of durable left ventricular assist devices (LVADs) as a bridge to transplant is increasing. However, comparative long-term data for LVAD-bridged versus directly transplanted pediatric recipients remain limited. In this study, we aimed to compare the early and long-term outcomes of pediatric heart transplantation with and without LVAD bridging. Methods: We retrospectively reviewed all pediatric patients who underwent orthotopic HTx at our institution between 2004 and 2024. 34 recipients were included, 17 bridged with durable LVAD support, and 17 transplanted without mechanical circulatory support. Perioperative characteristics, early postoperative complications, and long-term outcomes were compared between groups. Results: LVAD recipients had more advanced ventricular dysfunction, longer cardiopulmonary bypass and aortic cross-clamp times, and more frequent red blood cell transfusion requirements. Despite this higher-risk profile, early postoperative complications, early mortality, and ICU and hospital length of stay were similar between groups. Ten-year survival was 70.6% in the LVAD group, and 82.4% in the non-LVAD group (log-rank p = 0.365), and freedom from CAV and treated rejection did not differ significantly. Conclusions: In this single-center, two-decade experience, durable LVAD support enabled successful transplantation of high-risk pediatric candidates without compromising early or long-term post-transplant outcomes. LVAD bridging appears to be a safe and effective strategy in pediatric HTx. Full article

Durable left ventricular assist devices (LVADs) are an established and highly effective therapy for patients with advanced heart failure. Ongoing technological improvements and structured follow-up programs have significantly enhanced device durability, reduced complications, and improved long-term survival. Consequently, a growing number of patients with LVAD support require long-term outpatient care and increasingly present to both specialized and non-specialized hospitals, including for admissions unrelated to heart failure. In this context, echocardiography plays a central role. It is essential not only for routine follow-up at dedicated LVAD clinics but also for the assessment of cardiac status during inpatient admissions for extracardiac conditions. However, echocardiographic evaluation in LVAD patients is technically demanding and requires a solid understanding of LVAD physiology, device–heart interactions, and the specific hemodynamic conditions of continuous-flow support. Without this knowledge, standard echocardiographic parameters may be misleading. This review provides sonographers and cardiologists with a practical, clinically oriented framework for routine transthoracic echocardiography in patients with durable LVAD support. We summarize key principles of LVAD hemodynamics, discuss interpretation of LVAD console parameters, propose a standardized imaging protocol, and outline a structured approach to common echocardiographic findings in routine ambulatory and inpatient settings. Full article

Background: Sarcopenia is associated with adverse surgical outcomes across multiple specialties. The psoas muscle index (PMI), a radiologic marker of sarcopenia, may offer prognostic value in patients undergoing left ventricular assist device (LVAD) implantation, a population frequently characterized by frailty and high perioperative risk. Methods: We conducted a single-center retrospective study of 32 patients who underwent LVAD implantation between 2017 and 2022 and had preoperative CT imaging within 45 days. PMI was calculated from bilateral psoas muscle area at the L3 vertebral level, normalized to height. Sarcopenia was defined as the lowest sex-specific quartile of PMI. Primary outcomes were overall survival (OS), 90-day mortality, and postoperative length of stay (LOS). Results: Eight patients (25%) met criteria for sarcopenia. Sarcopenic and non-sarcopenic groups had similar demographics, comorbidities, and nutritional status. While there were no significant differences in overall, 90-day, or 1-year mortality between groups, among those who died post-implantation, the sarcopenic group had significantly shorter OS (median 38 vs. 597 days, p = 0.006). All sarcopenic deaths occurred within 90 days post-implant. LOS did not differ significantly between groups. Conclusions: PMI-defined sarcopenia was associated with early postoperative mortality among LVAD recipients, though not with overall or long-term mortality. Full article

Background/Objectives: Minimally invasive cardiac surgical (MICS) approaches to the implantation of left ventricular assist devices (LVADs) have gained increasing interest as alternatives to full median sternotomy (FS), particularly in patients with prior cardiac surgeries or elevated surgical risk. However, evidence regarding their safety, feasibility, and clinical outcomes remains fragmented. This systematic review aimed to evaluate the effectiveness and safety of minimally invasive techniques for LVAD implantation in comparison to standard sternotomy, with a focus on mortality, perioperative complications, intensive care unit (ICU) stay, and infection rates. Methods: A comprehensive literature search was conducted in PubMed, Web of Science, Science Direct, Cochrane Library, and Google Scholar up to 1 January 2025. Studies were included if they reported on adult patients undergoing LVAD implantation via minimally invasive thoracotomy or sternotomy-sparing approaches, with or without comparator groups. Data were extracted and synthesized qualitatively; the Newcastle–Ottawa Scale (NOS) was applied to assess the methodological quality of the included cohort and retrospective comparative studies. Results: A total of 12 studies involving 1448 patients were included (584 received MICS and 862 received FS). MICS techniques have demonstrated comparable short and mid-term survival outcomes, with trends toward reduced ICU stay, fewer reoperations for bleeding, and lower incidence of driveline infections. Some studies reported longer operative and cardiopulmonary bypass times in the MICS group. Among high-risk cohorts, such as patients with prior sternotomies or significant comorbidities, MICS was associated with lower morbidity and acceptable safety profiles. However, heterogeneity in patient selection, surgical protocols, and outcome definitions limited quantitative synthesis. Conclusions: Minimally invasive LVAD implantation is a viable alternative to conventional sternotomy in selected patient populations. While current data suggest favorable perioperative outcomes and equivalent survival, high-quality prospective studies are needed to confirm long-term benefits and to guide patient selection. MICS approaches should be considered within multidisciplinary teams experienced in advanced heart failure surgery. Full article

Background: Patients in cardiogenic shock (CS) often require prolonged mechanical circulatory support lasting longer than 14 days. Prolonged support with Impella 5.5 can improve outcomes in these patients. Here, we describe our experience with prolonged Impella 5.5 support. Methods: From January 2023 to June 2024, 64 patients receiving Impella 5.5 support for more than 14 days were identified. Information including demographics, heart failure etiology, and hospital course were collected. Results: Of the 64 patients identified, 54 were male, with an average age of 55.9 years. One patient was classified as SCAI class C, 41 as SCAI class D, and 22 as SCAI class E. Heart failure etiologies included 41 patients with non-ischemic cardiomyopathy, 10 with ischemic cardiomyopathy, 10 with acute myocardial infarction, 1 with cardiac allograft rejection, 1 with post-cavotricuspid isthmus ablation, and 1 with post-cardiotomy (aortic root replacement) CS. The average duration of Impella 5.5 support was 27.1 days. Escalation to Impella 5.5 was observed in 26 patients, with 15 having escalated from intra-aortic balloon pump and 11 from Impella CP. Overall survival, including heart recovery, orthotopic heart transplantation (OHT), or left ventricular assist device (LVAD), was 81.3% (52/64) in patients with Impella 5.5. Patients were discharged after OHT (27/64), cardiac recovery (13/64), or durable LVAD placement (12/64), and 12 patients expired. Conclusions: Our data suggest that Impella 5.5 provides durable support for patients beyond the 14-day period currently approved by the FDA for CS management. Further evaluation of long-term Impella 5.5 support for cardiac recovery or as a bridge to advanced therapies should be considered. Full article

Background: In advanced heart failure patients implanted with a fully magnetically levitated HeartMate 3 (HM3) Abbott left ventricular assist device (LVAD), it is unknown how the role of the LVAD outpatient clinic may affect the long-term survival after hospital discharge. Our objective is to share our standardized protocol for outpatient care, to describe the role of the LVAD outpatient clinic in postoperative long-term care after LVAD implantation, and to report survival. Methods: We retrospectively reviewed all patients implanted with HM3 LVAD in our institute between September 2015 and January 2025. Patients who received HeartWare Ventricular Assist Device (HVAD) and HeartMate 2 LVAD devices were excluded from our study, to ensure a homogenous cohort focusing on the latest and the only currently used LVAD device generation. We included a total of 48 patients. After LVAD patients are discharged from our center, they are followed in our outpatient clinic in 3-month intervals. During visits, bloodwork, EKG, wound inspection, and echocardiography are performed in addition to LVAD analysis. The role of the outpatient clinic is to detect early signs of deterioration or problems and act accordingly to prevent serious complications. Results: Thirty-three patients (68.7%) are still alive in 2025; two patients (4.2%) had a successful heart transplantation; and thirty-one patients (64.5%) are still on LVAD support. There were 210 total patient years of support. The mean time on device is 4.4 years. During the follow-up period we noticed 15 deaths (31.3%). Notably, there was no technical device-related death. Kaplan–Meier analysis estimated an overall survival rate of 97.9%, 92.8%, 83.7%, and 51.1% at 1, 2, 4, and 8 years, respectively. Conclusion: Strict control of patients after discharge in an outpatient clinic is essential for the long-term survival of these patients. A well-structured outpatient program is of utter importance to avoid LVAD-related complications and should be a cornerstone for the treatment, especially in non-transplant centers. Full article

Heart failure is a heterogeneous disorder that can lead to cardiogenic shock. Mechanical circulatory support (MCS) devices can replace the cardiac function in an attempt to bridge patients to transplant or they can serve as destination therapy to improve overall patient functionality and in turn quality of life. Currently utilized MCS devices include devices such as Left Ventricular Assist Devices (LVADs), Biventricular Assist Devices (BiVADs), Impella, Total Artificial Hearts (TAHs), and extracorporeal membrane oxygenation (ECMO). This literature review examines a range of studies, case reports, and meta-analyses to present current approaches to mechanical circulatory support (MCS), along with the challenges and limitations of existing devices, common complications, and overall survival and long-term outcomes following MCS therapy. Full article

Objectives: Heart failure (HF) remains a significant public health issue, with heart transplantation (HT) being the gold standard treatment for end-stage HF. The increasing use of mechanical circulatory support, particularly left ventricular assist devices (LVADs), as a bridge to transplant (BTT), presents new perspectives for increasingly complex clinical scenarios. This study aimed to compare long-term clinical outcomes in patients in heart failure with reduced ejection fraction (HFrEF) receiving an LVAD as BTT to those undergoing direct-to-transplant (DTT) without mechanical support, focusing on survival and post-transplant complications. Methods: A retrospective, single-center study included 105 patients who underwent HT from 2010. Patients were divided into two groups: BTT (n = 28) and DTT (n = 77). Primary endpoints included overall survival at 1 and 7 years post-HT. Secondary outcomes involved late complications, including organ rejection, renal failure, cardiac allograft vasculopathy (CAV), and cerebrovascular events. Results: At HT, the use of LVADs results in longer cardiopulmonary bypass and cross-clamping times in the BTT group; nevertheless, surgical complexity does not affect 30-day mortality. Survival at 1 year was 89.3% for BTT and 85.7% for DTT (p = 0.745), while at 7 years, it was 80.8% and 77.1%, respectively (p = 0.840). No significant differences were observed in the incidence of major complications, including permanent dialysis, organ rejection, and CAV. However, a higher incidence of cerebrovascular events was noted in the BTT group (10.7% vs. 2.6%). Conclusions: LVAD use as BTT does not negatively impact early post-transplant survival compared to DTT. At long-term follow-up, clinical outcomes remained similar across groups, supporting LVADs as a viable option for bridging patients to transplant. Full article

Background: Heart failure (HF) is a chronic condition that significantly affects morbidity and mortality. For patients with end-stage HF who are not candidates for heart transplantation, left ventricular assist devices (LVADs) provide mechanical circulatory support as a long-term solution, known as destination therapy (DT). Objective: This meta-analysis aims to synthesize evidence on the survival rates, complications, and quality-of-life improvements associated with LVADs used as destination therapy in patients with end-stage HF. Methods: A systematic search of databases, including PubMed, Embase, Cochrane Library, Web of Science, and Scopus, was conducted to identify relevant studies. Studies were selected based on predefined inclusion and exclusion criteria. Data from 12 studies were extracted and analyzed using a random-effects model. Survival rates, complications (e.g., infection and bleeding), and quality-of-life measures were the primary outcomes evaluated. Results: The analysis showed significant improvements in survival, with a pooled effect size of 0.848 (95% CI: 0.306–1.390, p = 0.002). Complication rates varied, with infections and bleeding being the most common adverse events. Quality of life also improved significantly post-LVAD implantation, with a standardized mean difference of 0.78 (95% CI: 0.65–0.91). Conclusions: LVADs as destination therapy provide a viable option for improving the survival and quality of life of end-stage HF patients, despite the associated risks of complications. Further research is needed to refine patient selection and management strategies to optimize outcomes. Full article

Heart transplantation (HT) is the gold standard therapy for advanced heart failure (ADHF), and LVADs as destination therapy are an option in non-HT candidates. Most patients with ADHF never receive HT or an LVAD, so alternative strategies are needed. Intermittent levosimendan can reduce HF hospitalizations in ADHF patients in the short term. It is uncertain whether the results of the comparison of inotropes with older-generation LVADs would have the same outcomes in the current era of ADHF patients treated with levosimendan, who are less sick but older. In this paper, we compare the use of two therapeutic strategies for end-stage HF in patients who are not candidates for HT: repetitive intermittent levosimendan vs. LVAD as destination therapy. To do so, we compare two multicenter cohorts of real-life patients from Spain: the LEVO-D registry and the REGALAD registry. In total, 715 patients coming from the two registries were found: 403 from LEVO-D and 312 from REGALAD. Non-adjusted median survival was shorter for LEVO-D patients, with the benefit for the LVADs seen only after the first year of therapy. The survival advantage for the LVAD cohort was also true after analysis of the matched cohort but, as in the non-matched analysis, the survival benefit was mainly shown after one year of follow-up. We conclude that in elderly ADHF non-HT candidates, LVAD therapy offers significantly better long-term outcomes when compared to intermittent levosimendan; thus, it should be considered in carefully selected candidates. On the other hand, in poor LVAD candidates or highly comorbid patients, intermittent inotropic support with levosimendan could be a reasonable alternative to LVAD, as 1-year outcomes are similar. Full article

Objectives: Patients in cardiogenic shock (CS) may be successfully bridged using intravascular micro-axial left ventricular assist devices (M-LVADs) for recovery or determination of definitive therapy. Methods: One hundred and seven CS patients implanted with M-LVADs from January 2020 to May 2024 were divided into four groups; group-1: 34 patients (transplant); group-2: 25 patients (LVAD); group-3: 42 patients (postcardiotomy CS (PCCS)); group-4: 6 patients (decision/recovery but excluded from analysis). Multivariable logistic regression and Multivariable Coxregression models identified predictors of early -hospital and late mortality, and Odds ratios (ORs) and hazard ratios (HRs) with p < 0.05, respectively, were considered statistically significant. SPSS 29.0 and Python 3.11.1. were used for analyses. Results: Complications included device-malfunction (6%), gastrointestinal bleed (9%), long-term hemodialysis (21%), axillary hematoma requiring re-exploration (10%), heparin-induced thrombocytopenia (4%) requiring heparin therapy cessation/initiation of argatroban infusion, and non-fatal stroke (11%). Early hospital mortality included 13 patients: 2 in group-1, 1 in group-2, 10 in group-3 (p = 0.02). In the Logistic-Regression model, category of CS requiring an M-LVAD was significant (OR = 4.7, p = 0.05). Patients were followed for 4.5 years (mean follow-up was 23 ± 17 months), and 23 deaths occurred; group-1: 3 patients, group-2: 5 patients, and group-3: 15 patients (p = 0.019). At 4.5 years, actuarial survival was 90.7 ± 5.1% in group-1, 79.2 ± 8.3% in group-2, 62.8 ± 7.7% in group-3 (p = 0.01). In the Cox-Regression model, M-LVAD category (HR = 3.63, p = 0.04), and long-term postoperative dialysis (HR = 3.9, p = 0.002) emerged as predictors of long-term mortality. Conclusions: In cardiogenic shock, mid-term outcomes demonstrate good survival with M-LVADs as bridge to transplant/durable LVADs and reasonable survival with M-LVADs as a bridge to recovery following cardiotomy, accompanied by reduced ECMO usage, and early ambulation/rehabilitation. Full article

The management of advanced heart failure (HF) has long posed significant challenges due to its complex and chronic nature. Heart transplantation, while effective, is not always feasible due to the limited availability of donor organs. In this context, long term mechanical circulatory support and mainly left ventricular assist devices (LVADs) have emerged as a vital intervention to fill this gap. LVAD superiority compared to medical therapy for some patients in advanced heart failure has been demonstrated either as a bridge to transplantation or as destination therapy. This literature review provides a comprehensive overview of the effectiveness, challenges, and advancements in the use of LVADs for treating advanced heart failure. It evaluates clinical outcomes associated with LVAD therapy, focusing on survival rates and quality of life improvements. The review synthesizes findings from recent studies, highlighting both the benefits and complications of LVAD implantation, such as infectious risk, thromboembolic events, hemorrhage and device malfunction. Additionally, it explores the latest technological and biomedical advancements in LVAD design, including innovations in biocompatibility, miniaturization, and power management. By examining current research, this review aims to elucidate how LVADs are transforming heart failure treatment and to offer insights into future directions for clinical practice and research. Full article

Heart transplantation remains the gold standard surgical treatment for advanced heart failure. Over time, medical therapies have achieved remarkable outcomes in terms of survival and quality of life, yet their results may be insufficient, even when maximized. The limited availability of organ donors and the selective criteria for heart transplant eligibility have led to a significant rise in the utilization of long-term mechanical circulatory support, including left ventricular assist devices. Patients receiving LVADs often present with multiple comorbidities, constituting a highly vulnerable population. Individuals living with LVADs may experience various long-term complications, such as bleeding, driveline infections, neurological events, and right ventricular dysfunction. Fortunately, the development of increasingly biocompatible LVAD devices in recent years has resulted in a notable reduction in these complications. This review aims to summarize the principal complications encountered by patients with LVADs throughout their treatment and the associated daily management strategies. Full article

Background: Donor shortage limits the utilization of heart transplantation, making it available for only a fraction of the patients on the transplant waiting list. Therefore, continuous-flow left ventricular assist devices (CF-LVADs) have evolved as a standard of care for end-stage heart failure. It is imperative therefore to investigate long-term survival in this population. Methods: This study assesses the impact of demographics, infections, comorbidities, types of cardiomyopathies, arrhythmias, and end-organ dysfunction on the long-term survival of LVAD recipients. The TriNetX database comprises de-identified patient information across healthcare organizations. The log-rank test assessed post-implant survival effects, while Cox regression was used in the univariate analysis to obtain the Hazard Ratio (HR). All analyses were conducted using the Python programming language and the lifelines library. Results: This study identified CMV, hepatitis A exposure, atrial fibrillation, paroxysmal ventricular tachycardia, ischemic cardiomyopathy, renal dysfunction, diabetes, COPD, mitral valve disease, and essential hypertension as risk factors that impact long-term survival. Interestingly, hypokalemia seems to have a protective effect and gender does not affect survival significantly. Conclusions: This is the first report of a detailed long-term survival assessment of the LVAD population using a decoded database. Full article

Long-term mechanical circulatory support by a left ventricular assist device (LVAD), with or without an additional temporary or long-term right ventricular (RV) support, is a life-saving therapy for advanced heart failure (HF) refractory to pharmacological treatment, as well as for both device and surgical optimization therapies. In patients with chronic non-ischemic cardiomyopathy (NICM), timely prediction of HF’s transition into its end stage, necessitating life-saving heart transplantation or long-term VAD support (as a bridge-to-transplantation or destination therapy), remains particularly challenging, given the wide range of possible etiologies, pathophysiological features, and clinical presentations of NICM. Decision-making between the necessity of an LVAD or a biventricular assist device (BVAD) is crucial because both unnecessary use of a BVAD and irreversible right ventricular (RV) failure after LVAD implantation can seriously impair patient outcomes. The pre-operative or, at the latest, intraoperative prediction of RV function after LVAD implantation is reliably possible, but necessitates integrative evaluations of many different echocardiographic, hemodynamic, clinical, and laboratory parameters. VADs create favorable conditions for the reversal of structural and functional cardiac alterations not only in acute forms of HF, but also in chronic HF. Although full cardiac recovery is rather unusual in VAD recipients with pre-implant chronic HF, the search for myocardial reverse remodelling and functional improvement is worthwhile because, for sufficiently recovered patients, weaning from VADs has proved to be feasible and capable of providing survival benefits and better quality of life even if recovery remains incomplete. This review article aimed to provide an updated theoretical and practical background for those engaged in this highly demanding and still current topic due to the continuous technical progress in the optimization of long-term VADs, as well as due to the new challenges which have emerged in conjunction with the proof of a possible myocardial recovery during long-term ventricular support up to levels which allow successful device explantation. Full article