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
Ari Cedars, Shelby Kutty, David Danford, Kurt Schumacher, S. R. Auerbach, D. Bearl, S. Chen, J. Conway, J. C. Dykes, N. Jaworski, A. Joong, A. Lorts, C. E. Mascio, D. L. S. Morales, R. A. Niebler, M. O'Connor, D. M. Peng, J. Philip, J. R. Reichman, D. N. Rosenthal, F. Zafar, C. VanderPluym, C. Villa, M. Zinn
Summary: The study found that the use of VAD in Fontan patients is effective, with the majority of patients being young and having a right ventricular morphology, as well as moderate to severe impairment in ventricular and atrioventricular function.
JOURNAL OF HEART AND LUNG TRANSPLANTATION
(2021)
Article
Engineering, Biomedical
Sarah E. Fahnhorst, Katie Brandewie, Tanya Perry, Alexander R. Opotowsky, Adam M. Lubert, Angela Lorts, David L. S. Morales, Chet R. Villa
Summary: This study retrospectively reviewed the use of durable, continuous flow single ventricular assist device (SVAD) therapy in Fontan circulatory failure patients. The findings suggest that continuous flow SVAD therapy can be effective for patients with Fontan circulatory failure and systolic dysfunction, serving as a bridge to candidacy or temporary support before transplantation.
Review
Cardiac & Cardiovascular Systems
K. Candis Jones-Ungerleider, Angela Rose, Kevin Knott, Sarah Comstock, Jonathan. W. W. Haft, Francis. D. D. Pagani, Paul. C. C. Tang
Summary: Women with advanced heart failure receive advanced surgical therapies at a lower rate compared to men, and the reasons for this disparity are largely unknown. Existing research indicates that females have higher mortality and experience bleeding, clotting, and right ventricular failure more frequently following LVAD implantation. However, there is limited understanding of the pre-operative factors that contribute to the lower-than-expected LVAD implant rates in this population. More focused research is needed to identify and address disparities in advanced heart failure therapy delivery for women and other underserved populations.
FRONTIERS IN CARDIOVASCULAR MEDICINE
(2022)
Article
Cardiac & Cardiovascular Systems
Dominic Emerson, Joanna Chikwe, Pedro Catarino, Mohamed Hassanein, Luqin Deng, Ryan S. Cantor, Amy Roach, Robert Cole, Fardad Esmailian, Jon Kobashigawa, Jaime Moriguchi, James K. Kirklin
Summary: In contemporary practice, elderly patients receiving LVADs showed improved survival, increased functional capacity, enhanced quality of life, and fewer complications compared with younger patients.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
(2021)
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
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)
Article
Cardiac & Cardiovascular Systems
Ofer Havakuk, Aviram Hochstadt, Sapir Sadon, Michal Laurel Perl, Ben Sadeh, Assi Milwidsky, Orly Ran Sapir, Yoav Granot, Lior Lupu, Erez Levi, Ariel Farkash, Yanai Ben Gal, Shmuel Banai, Yan Topilsky
Summary: This study demonstrates that long-term stabilization of patients entering a left ventricular assist device (LVAD) program is possible with the use of aggressive conservative therapy.
Article
Cardiac & Cardiovascular Systems
Joseph Philip, Emma Powers, Desiree Machado, Dalia Lopez Colon, Dipankar Gupta, Renata Shih, Mohammad Ebraheem, Curt Fudge, Mark Bleiweis
Summary: This retrospective study describes successful use of paracorporeal pulsatile VADs in high-risk single ventricle patients before or after the first stage of palliation, showing it as a feasible bridge-to-transplant option. Patients implanted with Berlin Heart EXCOR VAD were early implanted with good survival outcomes.
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
(2021)
Article
Cardiac & Cardiovascular Systems
Andrew N. Rosenbaum, Bradley W. Ternus, Siddharth Pahwa, John M. Stulak, Alfredo L. Clavell, Sarah D. Schettle, Atta Behfar, Jacob C. Jentzer
Summary: In patients undergoing left ventricular assist device implantation, right ventricular stroke work index, right heart catheterization, cardiopulmonary bypass time, and ultrafiltration are strongly associated with incident INT-LD and decreased 1-year survival. Optimization of these factors may reduce the risk of liver dysfunction but further validation is needed.
ANNALS OF THORACIC SURGERY
(2021)
Article
Medicine, General & Internal
Alexander A. Brescia, Tessa M. F. Watt, Francis D. Pagani, Thomas M. Cascino, Min Zhang, Jeffrey S. McCullough, Supriya Shore, Donald S. Likosky, Keith D. Aaronson, Michael P. Thompson
Summary: The study found that a significant proportion of LVAD recipients are ineligible for clinical trials, and that mortality rates are higher among those who are ineligible compared to those who are eligible. The results suggest that criteria for clinical trial eligibility should be more reflective of real-world experience.
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
Federico Landra, Carlotta Sciaccaluga, Maria Concetta Pastore, Guglielmo Gallone, Maria Barilli, Chiara Fusi, Marta Focardi, Luna Cavigli, Flavio D'Ascenzi, Benedetta Maria Natali, Sonia Bernazzali, Massimo Maccherini, Serafina Valente, Matteo Cameli, Giulia Elena Mandoli
Summary: This study evaluated the predictive ability of right ventricular myocardial work on right heart failure and long-term mortality after left ventricular assist device implantation. The study found that lower right ventricular global work efficiency was associated with the occurrence of early right heart failure, and in long-term follow-up, patients with lower right ventricular global work efficiency had higher mortality rates.
EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING
(2023)
Review
Cardiac & Cardiovascular Systems
Madeleine Townsend, Aamir Jeewa, Iki Adachi, Mohammed Al Aklabi, Osami Honjo, Kathryn Armstrong, Holger Buchholz, Jennifer Conway
Summary: Ventricular assist devices (VADs) are increasingly used to support patients with congenital heart disease and single-ventricle physiology, necessitating special consideration for effective mechanical circulatory support.
CANADIAN JOURNAL OF CARDIOLOGY
(2022)
Article
Hematology
Kristin Klaeske, Maja-Theresa Dieterlen, Sandra Eifert, Ute Scholz, Jens Garbade, Khalil Jawad, Franz Sieg, Michael A. Borger, Anna L. Meyer
Summary: This study compared platelet receptor expression patterns and oxidative stress levels between LVAD patients with non-surgical bleeding (NSB) and those without coagulation disorders. The findings suggested that changes in three platelet receptors (GPIb alpha, P-selectin, and PECAM-1) and elevated oxidative stress may play a role in bleeding complications following LVAD implantation.
JOURNAL OF THROMBOSIS AND HAEMOSTASIS
(2021)