China
Africa
Explore chapters and articles related to this topic
Deaths Following Cardiac Surgery and Invasive Interventions
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
The use of an LVAD, as a bridge to heart transplantation or as a ‘bridge to recovery’,8 or as destination therapy for patients with advanced heart failure has reduced mortality and morbidity in these patients (see Fig. 9.7). There is strong evidence that with LVAD unloading, particularly when combined with pharmacological treatment, in acute heart failure, the patients’ myocardial function can recover completely, allowing device removal and avoiding the need for transplantation. This is inserted as an alternative to transplantation. Miniaturization, increased device durability and complete implantability results in effective long-term use in heart failure.
Mechanical Circulatory Support
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Due to the significant morbidity and mortality associated with advanced heart failure, durable MCS has become an increasingly important therapy. LVADs, the most commonly implanted durable devices, improve both survival and quality of life. The first generation intracorporeal LVADs, designed to mimic the pulsatility of the heart, were originally used in the 1990s as a transition therapy in patients awaiting heart transplant. In 2001, the REMATCH trial demonstrated a survival benefit with LVAD treatment compared to optimal medical therapy in patients who were not candidates for transplantation [3]. This study opened the door for LVADs to be used not only as a bridge to transplant (BTT), but also as a treatment strategy for patients ineligible for transplant, i.e., destination therapy (DT). However, the poor durability and complications of the first-generation devices limited the therapeutic potential for DT patients. Second-generation devices implemented significant design changes, shifting from pulsatile pumps to axial continuous-flow pumps, resulting in a smaller profile and improved durability. DT patients treated with the HeartMate II (Abbott) experienced greater survival, free from disabling stroke and reoperation for device malfunction as compared to those treated with a pulsatile device [4]. However, adverse events remained common, and later pump thrombosis emerged as a significant problem [5].
Heart failure with reduced ejection fraction in older adults
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
The left ventricular assist device (LVAD) has become an important intervention for patients with end-stage HFrEF. Although LVADs were initially developed as a temporary bridge to cardiac transplantation (161), in recent years LVADs have been increasingly used as destination therapy in patients who are not transplant candidates (161–163). The first-generation LVAD, a relatively bulky pulsatile flow device, showed a reduction in 1-year mortality compared to medical therapy in the REMATCH trial (162). Data from the Mechanical Circulatory Support Research Network (MCSRN) registry demonstrate that of 1149 recipients of continuous-flow LVADs, 1-year mortality occurred in 25% (40/163) of patients ≥70 years and 16% (158/986) of patients <70 years. Age ≥70 years had no significant independent association with 1-year mortality (HR, 0.94; 95% CI, 0.70–1.26; p = 0.67). Compared with patients <70 years, older patients had similar 1-year rates of device thrombosis and stroke, but higher rates of gastrointestinal bleeding (164).
Dalbavancin as chronic antibiotic suppression therapy for left ventricular assist device driveline infection due to methicillin-resistant Staphylococcus aureus: a case report
Published in Journal of Chemotherapy, 2023
Carlo Pallotto, Sara Tordi, Romina Pantanella, Daniele Rosignoli, Daniela Francisci
Left Ventricular Assist Devices (LVADs) represent an important therapeutic option in the management of advanced heart failure both as bridge (to transplantation and to recovery) and as destination therapy. In recent decades, significant progress has been made in the technological advancement of LVADs; after the advent of continuous flow devices, the survival rate consistently improved - currently at 81% at 1 year - and the rate of LVAD-related infections gradually decreased [1]. However, about one-third of patients with LVAD have an infective complication within two years of implantation, with a high rate of morbidity and mortality [1–3]. Driveline infections (DLIs) are the most frequent LVAD related infections and affect about 12-35% of patients [1]. The most common pathogens involved are skin flora and enteric bacteria, in particular Staphylococcus aureus, either methicillin-susceptible (14-56%) or methicillin-resistant (4-30%) [1]. The treatment of this kind of infection could be challenging: comorbidities, frailty, drug-drug interactions and the necessary long duration of antibiotics administration are only a part of the difficulties a physician has to deal with [4]. Dalbavancin could represent a valid option for the treatment of LVAD infections because of its long half-life and good tolerability [5].
A Bridge to Nowhere
Published in The American Journal of Bioethics, 2023
Implantation of any MCS device—of which Extracorporeal Membrane Oxygenation (ECMO) is a type—advances a patient to a “bridging period” in which the patient is supported to one of three outcomes: recovery, death, or organ transplantation. In adults, durable ventricular assist devices (VADs), another form of MCS, that allow for hospital discharge are also often used as “destination therapy,” intended for permanent support, with obligate lifelong device dependency being the “destination.” The choice between “bridge to transplant” and “destination therapy” in adults is typically a matter of patient preference, with the decision usually made prior to implant surgery (McIlvennan et al. 2014). Other adult patients choose destination therapy because medical or social co-morbidities preclude transplantation. In either case, implicit in the decision to pursue destination VAD therapy is the patient’s understanding that death may result from non-cardiac causes (e.g. cancer) and may require voluntary cessation of device support for death to occur. For adults, this eventuality is typically considered prior to device implant, often with the assistance of evidence-based patient decision aids (McIlvennan et al. 2014).
Device profile of the heartware HVAD system as a bridge-to-transplantation in patients with advanced heart failure: overview of its safety and efficacy
Published in Expert Review of Medical Devices, 2019
Silvia Mariani, Jasmin Sarah Hanke, Tong Li, Ali Saad Merzah, Anamika Chatterjee, Ezin Deniz, Axel Haverich, Jan D. Schmitto, Günes Dogan
A further impulse in this field was given by the development of less invasive surgical techniques for the implantation of centrifugal LVADs. In our experience, BTT patients represent the category of patients, which might benefit the most from less invasive LVAD implantation, reducing the risks of a resternotomy and, potentially, influencing the early posttransplant recovery. However, literature is still lacking comparative data prospectively examining the putative benefits of less invasive approaches with respect to BTT outcomes or ease of the transplant operation. Moreover, the largest number of studies available in literature describes the performance of HVAD as BTT in the first years of its use. Meanwhile, the medical management of LVAD patients and surgical techniques has undergone significant improvements leading to even better results and the shift of LVAD therapy toward a wider use as destination therapy in patients who are excluded from transplantation listing.