Explore chapters and articles related to this topic
Advanced Therapeutic Options in Acute Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Tiffany Dong, Aditi Nayak, Alanna Morris
Complications with VADs include ischemic and hemorrhagic stroke, gastrointestinal bleeding, pump thrombosis, hemolysis, and acquired von Willebrand factor deficiency secondary to shearing of the von Willebrand protein in axial-flow pumps. Patients are also at risk of driveline infection, worsening aortic regurgitation, and RV failure. Risk factors for RV failure include pre-existing RV dysfunction,37 higher pulmonary vascular resistance, and destination therapy indication.
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].
Anticoagulant treatment and bleeding complications in patients with left ventricular assist devices
Published in Expert Review of Cardiovascular Therapy, 2020
Paul L. den Exter, Saskia L.M.A. Beeres, Jeroen Eikenboom, Frederikus A. Klok, Menno V. Huisman
LVAD pump thrombosis is a major complication after LVAD implantation, causing significant morbidity and mortality. Pump thrombosis is defined by the formation of a blood clot within any or all of the components of the LVAD system, including the titanium inflow cannula, the pump rotator, and the outflow graft [34]. Thrombus can either originate in the pump itself or travel to the pump from the left atrium or ventricle, or from right-sided cardiac chambers through a septal defect. Pump thrombosis results in pump failure leading to acute heart failure and is associated with embolic complications such as ischemic stroke. In the previously mentioned REMATCH trial, 16% of the LVAD patients were diagnosed with stroke, accounting for a yearly incidence of 0.19. The majority of events occurred in the direct postoperative period [35].
Early signatures of bleeding and mortality in patients on left ventricular assist device support: novel methods for personalized risk-stratification
Published in Biomarkers, 2019
Tara Shrout, Travis Sexton, Olga Vsevolozhskaya, Maya Guglin, Alexis Shafii, Susan Smyth
Clinical data were collected via the EMR for inpatient and outpatient visits at the University of Kentucky and entered into a de-identified and protected database (REDCap). Platelet concentration and mean platelet volume (MPV) during the first seven days following implantation were obtained from each patient’s EMR. Additionally, MPV was recorded from EMR at each patient’s 30 day follow-up visit. Clinical outcomes were captured within one year following LVAD implantation and included GI bleeding, haemorrhagic stroke, embolic stroke, pump thrombosis, driveline infection, readmission and all-cause mortality. GI bleeding was defined by endoscopic diagnosis or documented guaiac-positive stool, melena or hematochezia. Haemorrhagic and embolic stroke events were diagnosed by CT or MRI. Pump thrombosis was defined by documented diagnosis with resultant medical or surgical intervention. Driveline infection was defined by documented clinical diagnosis and treatment.
Continuous-flow LVADs in the Nordic countries: complications and mortality and its predictors
Published in Scandinavian Cardiovascular Journal, 2019
Oscar Ö. Braun, Johan Nilsson, Finn Gustafsson, Göran Dellgren, Arnt E. Fiane, Karl Lemström, Laila Hubbert, Laila Hellgren, Lars H. Lund
The largest obstacles to a more widespread use of LVADs are the burden of complications, particularly complications related to bleeding and thrombosis. Stroke is one of the major complications after LVAD implantation and the incidence of stroke has been reported to be between 8–30% in clinical trials and is associated with increased mortality [6,8–11]. In the present cohort the incidence of stroke was 12%. There were more strokes in the DT group compared to the BTT group. However, within the BTT group there were no differences between the two pump types. The incidences of pump thrombosis was low and comparable to that of recently reported in clinical trials [9,14]. Bleeding is the most frequent complication leading to re-hospitalization after LVAD implantation. In particular gastro-intestinal bleeding (GIB) is frequent and occurred in 15% to over 30% of the patients in recent clinical trials [9,14]. The overall incidence of GIB in the present study were low, probably because of a shorter duration of support and younger age compared to other reports, but there was a clear increased risk in the DT cohort which further emphasizes the fragility of this patient group.