Article
Cardiac & Cardiovascular Systems
Jared P. Beller, J. Hunter Mehaffey, Zachary K. Wegermann, Maria Grau-Sepulveda, Sean M. O'Brien, J. Matthew Brennan, Vinod Thourani, Vinay Badhwar, Francis D. Pagani, Gorav Ailawadi, Leora T. Yarboro, Nicholas R. Teman
Summary: Patients with severe right ventricular failure during durable left ventricular assist device implantation may benefit from the use of RVAD over VA-ECMO. Regardless of the type of support, initiation at the index operation was associated with improved outcomes.
ANNALS OF THORACIC SURGERY
(2022)
Editorial Material
Cardiac & Cardiovascular Systems
Masashi Kawabori, Taylor Nordan, Navin K. Kapur, Gregory S. Couper
Summary: Right ventricular failure has a negative impact on prognosis post left ventricular assist device implantation. However, a strategy for primary prevention of right ventricular failure in high-risk patients has been proposed.
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
(2021)
Review
Cardiac & Cardiovascular Systems
Claudio A. Bravo, Andrew G. Navarro, Karanpreet K. Dhaliwal, Maziar Khorsandi, Jeffrey E. Keenan, Parvathi Mudigonda, Kevin D. O'Brien, Claudius Mahr
Summary: Left ventricular assist device (LVAD) therapy is a life-saving option for patients with advanced heart failure who do not respond to medical treatment. However, a significant percentage of LVAD patients develop right heart failure (RHF), which is associated with poor outcomes. The mechanisms of RHF are complex, involving patient factors, surgical factors, and hemodynamic factors. Despite advances in surgical techniques and LVAD technology, RHF remains a major cause of morbidity and mortality among LVAD patients. Current medical therapies for RHF are limited, and cardiac transplantation or supportive management are the only options for these patients. Efforts to predict the risk of RHF in LVAD patients have been challenging, with varying definitions of RHF in different studies. Additionally, most research in this field has focused on early-onset RHF, while late-onset RHF is increasingly recognized as a significant problem. This review aims to describe the unique physiology of the right ventricle and the changes caused by LVADs that may contribute to both early- and late-onset RHF. The available treatments for RHF, including mechanical circulatory support and medical therapies, will also be analyzed.
FRONTIERS IN CARDIOVASCULAR MEDICINE
(2022)
Article
Cardiac & Cardiovascular Systems
Veli K. Topkara, Pierre Elias, Rashmi Jain, Gabriel Sayer, Daniel Burkhoff, Nir Uriel
Summary: This study used machine learning models to predict myocardial recovery in LVAD patients and demonstrated that these models outperformed traditional statistical models in predicting LVAD-induced myocardial recovery. ML models can be helpful in identifying subsets of LVAD patients who may have a better response to myocardial recovery protocols.
CIRCULATION-HEART FAILURE
(2022)
Article
Engineering, Biomedical
Arjun Bahl, Binish Qureshi, Kevin Zhang, Claudio Bravo, Claudius Mahr, Song Li
Summary: Explainable machine learning methods were used to identify preimplant patient factors associated with right heart failure (RHF) after left ventricular assist device (LVAD) implantation, providing insights for patient optimization strategies.
Article
Cardiac & Cardiovascular Systems
Anubodh S. Varshney, Ersilia M. DeFilippis, Jennifer A. Cowger, Ivan Netuka, Sean P. Pinney, Michael M. Givertz
Summary: With the increasing prevalence of advanced heart failure, treatment options such as heart transplantation and LVAD support have shown to improve quality of life and extend survival. Recent advancements, including the use of HeartMate 3 in clinical practice and revisions to the organ allocation system, have led to better management of LVAD-related complications. Although contemporary LVAD recipients have higher illness severity preoperatively, they have higher survival rates and lower adverse event rates compared to previous eras. However, challenges such as bleeding, infection, neurologic events, and right ventricular failure still limit the wider implementation of LVAD support. Ongoing efforts to optimize management of current LVAD devices and develop next-generation devices are expected to further enhance outcomes for patients with advanced heart failure.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
(2022)
Review
Cardiac & Cardiovascular Systems
Eduard Rodenas-Alesina, Darshan H. Brahmbhatt, Vivek Rao, Marcus Salvatori, Filio Billia
Summary: This review discusses the occurrence of RVF in LVAD patients and provides multiple tools for predicting the risk of RVF, aiding in the selection of suitable LVAD candidates. It also presents a multidisciplinary approach to early RVF management and the indications and management of right ventricular assist devices.
FRONTIERS IN CARDIOVASCULAR MEDICINE
(2022)
Review
Medicine, General & Internal
Alessia Gambaro, Gianmarco Lombardi, Francesco Onorati, Leonardo Gottin, Flavio Luciano Ribichini
Summary: LVAD implantation has complex effects on the kidneys, particularly regarding renal function. Creatinine-based eGFR formulas help in assessing patient prognosis, while deterioration in renal function in LVAD patients negatively impacts outcomes.
EUROPEAN JOURNAL OF CLINICAL INVESTIGATION
(2021)
Article
Cardiac & Cardiovascular Systems
Shusaku Maeda, Hidetsugu Asanoi, Koichi Toda, Shigeru Miyagawa, Yasushi Yoshikawa, Hiroki Hata, Daisuke Yoshioka, Satoshi Kainuma, Masataka Igeta, Yoshiki Sawa
Summary: This study visualized the dynamic circulatory equilibrium of acute RVF after LVAD implantation using a new four-quadrant diagram, and stratified LVAD patients into different groups based on duration of postoperative inotropic support. The novel presentation showed characteristics such as increased CVP, relatively small increase in CI, and concomitant impairment of pressure natriuresis in acute RVF. The four-quadrant presentation serves as a useful guide for prompt and optimal management of circulatory malfunction.
AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY
(2021)
Article
Cardiac & Cardiovascular Systems
Timothy J. George, Jenelle Sheasby, Greg Milligan, Nitin Kabra, J. Michael Dimaio, David A. Rawitscher, Aasim Afzal
Summary: Although left ventricular assist device (LVAD) implant is associated with increased survival in patients with end-stage heart failure, severe right ventricular failure requiring right ventricular assist device (RVAD) placement is associated with increased short-term morbidity and mortality. This retrospective study evaluated LVAD implants at a nontransplant center and found that the need for a RVAD was associated with higher operative mortality, decreased 1-year and 2-year survival rates. However, in patients who survived their index hospitalization, the mortality rates were similar. Carefully selected patients with biventricular failure may benefit from an LVAD implant, even if an RVAD is needed.
AMERICAN JOURNAL OF CARDIOLOGY
(2023)
Article
Cardiac & Cardiovascular Systems
Maryam Ajmal, Aisha Ajmal, Maryam Rizvi, Umar Salim, Lei Huang
Summary: This study aimed to investigate the changes in myocardial gene expression profile after LVAD implantation and their molecular biological significance. The results showed that inflammatory signaling pathway is crucial for the pathophysiology after LVAD implantation and chemokines mediate cardiac inflammatory response and tissue remodeling through GPCR-ligand binding.
FRONTIERS IN CARDIOVASCULAR MEDICINE
(2022)
Article
Cardiac & Cardiovascular Systems
Rashmi Jain, Lauren K. Truby, Veli K. Topkara
Summary: Residual MR is associated with worse clinical outcomes in patients supported by LVAD, and strategies to minimize MR should be considered in LVAD patients with residual MR.
JOURNAL OF HEART AND LUNG TRANSPLANTATION
(2022)
Article
Cardiac & Cardiovascular Systems
Michael Brener, Nadira B. Hamid, Justin A. Fried, Amirali Masoumi, Jayant Raikhelkar, Manreet K. Kanwar, Mohit Pahuja, Giulio M. Mondellini, Lorenzo Braghieri, David T. Majure, Paolo C. Colombo, Melana Yuzefpolskaya, Gabriel T. Sayer, Nir Uriel, Daniel Burkhoff
Summary: This study quantified changes in RV systolic and diastolic function with varying LVAD speeds and found that interventricular interaction can improve RV compliance and impair systolic function. The overall effect on RV performance was found to be heterogeneous, with further research needed to understand the factors influencing this interaction.
JOURNAL OF CARDIAC FAILURE
(2021)
Article
Cardiac & Cardiovascular Systems
Edo Y. Birati, Samer S. Najjar, Ryan J. Tedford, Brian A. Houston, Supriya Shore, Esther Vorovich, Pavan Atluri, Kimberly Urgo, Maria Molina, Susan Chambers, Nicole Escobar, Eileen Hsich, Jerry D. Estep, Kevin M. Alexander, Jeffrey J. Teuteberg, Sunit-Preet Chaudhry, Ashwin Ravichandran, Adam D. DeVore, Kenneth B. Margulies, Thomas C. Hanff, Ross Zimmer, Arman Kilic, Joyce W. Wald, Himabindu Vidula, John Martens, Emily A. Blumberg, Jeremy A. Mazurek, Anjali T. Owens, Lee R. Goldberg, Jesus Alvarez-Garcia, Donna M. Mancini, Noah Moss, Michael Genuardi
Summary: This study describes the clinical characteristics and outcomes of COVID-19 in patients with end-stage heart failure and durable LVADs. The most common presenting symptoms were cough, fever, and fatigue, with 18% of patients being asymptomatic at diagnosis. Over half of the patients required hospitalization, with a high mortality rate of 20%. Understanding these characteristics is crucial in improving the outcomes of this complex patient population.
CIRCULATION-HEART FAILURE
(2021)
Article
Cardiac & Cardiovascular Systems
Fabian Jimenez Contreras, Michelle Mendiola Pla, Jacob Schroder, Benjamin Bryner, Richa Agarwal, Stuart D. Russell, Jacqueline Mirza, Mani A. Daneshmand, Carmelo Milano
Summary: Long-term LVAD support can accelerate the progression of AI. The HM3 LVAD, with greater hemocompatibility, is compared to HM2 in terms of the rate of MSAI progression.
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
(2022)
Review
Engineering, Biomedical
Neel K. Ranganath, Majid Rashidi, James F. Antaki, Katherine G. Phillips, Zachary N. Kon, Deane E. Smith, Alex Reyentovich, Nader Moazami
Article
Engineering, Biomedical
Grant W. Rowlands, Francis D. Pagani, James F. Antaki
Article
Engineering, Biomedical
Grant W. Rowlands, James F. Antaki
Article
Computer Science, Information Systems
Faezeh Movahedi, Robert L. Kormos, Lisa Lohmueller, Laura Seese, Manreet Kanwar, Srinivas Murali, Yiye Zhang, Rema Padman, James F. Antaki
IEEE JOURNAL OF BIOMEDICAL AND HEALTH INFORMATICS
(2020)
Article
Engineering, Biomedical
Rodrigo Mendez Rojano, Mansur Zhussupbekov, James F. Antaki
Summary: This study investigates the risk of thrombosis around the VAD inlet cannula and reveals the crucial role of biochemical factors in thrombus formation, taking a step towards the long-term objective of incorporating clinically relevant pharmacological kinetics into simulations of inflow cannula thrombosis.
Article
Biophysics
Mansur Zhussupbekov, Wei -Tao Wu, Megan A. Jamiolkowski, Mehrdad Massoudi, James F. Antaki
Summary: This study investigated the factors influencing thrombus formation in blood flow over a micro-crevice using numerical simulations, demonstrating the roles of flow, shear rate, and surface chemistry in platelet deposition patterns. The results provide insights for the design and operation of blood-contacting devices.
JOURNAL OF BIOMECHANICS
(2021)
Article
Engineering, Biomedical
Mansur Zhussupbekov, Rodrigo Mendez Rojano, Wei-Tao Wu, Mehrdad Massoudi, James F. Antaki
Summary: The von Willebrand Factor is a mechano-sensitive protein in the blood that plays a key role in platelet adhesion and aggregation. Its conformational changes from a collapsed to a stretched state regulate its hemostatic function and thrombogenic effect. A continuum model of vWF unfolding was developed within a multi-constituent model of platelet-mediated thrombosis, considering two interconvertible vWF species corresponding to different conformational states. The model was verified in microfluidic systems designed for studying high-shear vWF-mediated thrombosis and von Willebrand Disease screening, showing high concentration of stretched vWF in regions where occlusive thrombosis occurred. The model can be used for numerical simulations in complex geometries, but may face challenges when extending to 3-D arbitrary flows and turbulent flows.
ANNALS OF BIOMEDICAL ENGINEERING
(2021)
Article
Biochemical Research Methods
Constance M. Robbins, Syeda Tabassum, Molly F. Baumhauer, Jason Yang, James F. Antaki, Jana M. Kainerstorfer
Summary: Longitudinal tracking of hemodynamic changes in the breast using spatial frequency domain imaging (SFDI) has shown potential for predicting outcomes of neoadjuvant chemotherapy (NAC). A two-layer SFDI inverse model that accounts for varying melanin concentration in the skin was investigated to improve the discrimination of optical properties of deep tissue in the breast. The results suggest that the handheld SFDI device and two-layer model have the potential to imaging hemodynamic responses and predict the efficacy of NAC in patients with different skin tones.
JOURNAL OF BIOMEDICAL OPTICS
(2021)
Article
Cardiac & Cardiovascular Systems
Faezeh Movahedi, Rema Padman, James F. Antaki
Summary: In the left ventricular assist device domain, the receiver operating characteristic is commonly used to evaluate classifier performance. However, due to imbalanced data, the receiver operating characteristic can provide a distorted view of classifiers' ability to predict short-term mortality. This study introduces the precision recall curve as a supplemental metric that provides better insight into the performance of left ventricular assist device classifiers.
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
(2023)
Review
Engineering, Biomedical
Wenxuan He, Jonathan T. Butcher, Grant W. Rowlands, James F. Antaki
Summary: Titanium alloys, traditionally used in blood-contacting cardiovascular devices, have led to adverse coagulation and thrombogenesis. To improve hemocompatibility, LVAD manufacturers introduced powder sintering on blood-wetted surfaces. However, the biologic response to sintered titanium has been inconsistent, leading to the need for a unified taxonomy and a deterministic model for the development of a hemocompatible neointima.
Article
Engineering, Biomedical
Rodrigo Mendez Rojano, Mansur Zhussupbekov, James F. Antaki, Didier Lucor
Summary: This study performs an uncertainty quantification analysis of a multi-constituent thrombosis model using time-evolving polynomial chaos expansions. The analysis includes a global sensitivity analysis using Sobol' coefficients. Six out of 15 parameters were found to be most influential in the simulation variability, and parameter interactions were also identified. The surrogate model was able to predict realistic closure times and could be used to guide anti-platelet therapies.
INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING
(2022)
Editorial Material
Engineering, Biomedical
James F. Antaki
Article
Biochemical Research Methods
Rodrigo Mendez Rojano, Angela Lai, Mansur Zhussupbekov, Greg W. Burgreen, Keith Cook, James F. Antaki
Summary: Over the past decade, computational models of device-related thrombosis have mainly focused on platelet activity, neglecting other important factors such as fibrin formation. In this study, we augment an existing platelet-based model with a partial model of the coagulation cascade to improve predictions in low-shear devices. The results of our simulations closely match experimental observations and confirm that considering coagulation reactions and fibrin formation is essential for accurately predicting thrombus formation in medical devices.
PLOS COMPUTATIONAL BIOLOGY
(2022)
Article
Chemistry, Multidisciplinary
Xin-Yi Yuan, Yue Hua, Nadine Aubry, Mansur Zhussupbekov, James F. Antaki, Zhi-Fu Zhou, Jiang-Zhou Peng
Summary: This study develops a data-driven reduced-order model based on a deep convolutional neural network for real-time and accurate prediction of drug trajectory and concentration field in therapy, showing high performance and speed.
APPLIED SCIENCES-BASEL
(2022)
Article
Biochemistry & Molecular Biology
Matt T. Oberdier, James F. Antaki, Alexander Kharlamov, Stephen C. Jones
Summary: In a pilot study using a closed cranial window model in rats, it was found that after a transient increase, cortical blood flow decreased to between 25% and 75% of baseline, without exceeding thresholds for electrical signaling or membrane integrity. This may partially explain why some episodes of elevated ICP remain benign.
ANIMAL MODELS AND EXPERIMENTAL MEDICINE
(2021)