scholarly journals Triple bridge of mechanical circulatory support to heart transplantation listing: A case report

2019 ◽  
Vol 7 ◽  
pp. 2050313X1983481
Author(s):  
Magdy M El-Sayed Ahmed ◽  
Mathew Thomas ◽  
Samuel Jacob ◽  
Ian A Makey ◽  
Kevin P Landolfo ◽  
...  
Keyword(s):  
Renal Function ◽  
Heart Transplantation ◽  
Ventricular Assist Device ◽  
Mechanical Circulatory Support ◽  
Complete Recovery ◽  
Circulatory Support ◽  
Intermittent Hemodialysis ◽  
Assist Device ◽  
Ventricular Assist ◽  
Artery Disease

A 60-year-old male patient presented to an outside hospital with severe cardiogenic shock. A triple bridge of mechanical circulatory support was utilized to transition him to heart transplantation listing. Initially, coronary artery disease was percutaneously treated and Impella 2.5 was used as mechanical circulatory support for 5 days followed by the second Impella 2.5 for 4 days. Veno-arterial extracorporeal membrane oxygenation support was deployed for 16 days. This was exchanged for HeartWare ventricular assist device support as the third stage of mechanical circulatory support to heart transplantation listing. The patient experienced acute renal failure which was managed by continuous renal replacement therapy then intermittent hemodialysis with eventual complete recovery of the renal function. He was discharged home 56 days after HeartWare ventricular assist device implantation with stable hemodynamic, intact neurologic status and fully recovered renal function. Currently, the patient is listed for heart transplantation.

scholarly journals Pediatric Palliative Care in the Heart Failure, Ventricular Assist Device and Transplant Populations: Supporting Patients, Families and Their Clinical Teams

Children ◽  
2021 ◽  
Vol 8 (6) ◽  
pp. 468
Author(s):  
Kyle D. Hope ◽  
Priya N. Bhat ◽  
William J. Dreyer ◽  
Barbara A. Elias ◽  
Jaime L. Jump ◽  
...  
Keyword(s):  
Heart Failure ◽  
Palliative Care ◽  
Heart Transplantation ◽  
Ventricular Assist Device ◽  
Mechanical Circulatory Support ◽  
Pediatric Palliative Care ◽  
Circulatory Support ◽  
Assist Device ◽  
Ventricular Assist ◽  
Patients With Heart Failure

Heart failure is a life-changing diagnosis for a child and their family. Pediatric patients with heart failure experience significant morbidity and frequent hospitalizations, and many require advanced therapies such as mechanical circulatory support and/or heart transplantation. Pediatric palliative care is an integral resource for the care of patients with heart failure along its continuum. This includes support during the grief of a new diagnosis in a child critically ill with decompensated heart failure, discussion of goals of care and the complexities of mechanical circulatory support, the pensive wait for heart transplantation, and symptom management and psychosocial support throughout the journey. In this article, we discuss the scope of pediatric palliative care in the realm of pediatric heart failure, ventricular assist device (VAD) support, and heart transplantation. We review the limited, albeit growing, literature in this field, with an added focus on difficult conversation and decision support surrounding re-transplantation, HF in young adults with congenital heart disease, the possibility of destination therapy VAD, and the grimmest decision of VAD de-activation.

scholarly journals Experience with the HeartMate II Left Ventricular Assist Device in Patients Older than 60 Years

2019 ◽  
Vol 22 (2) ◽  
pp. E124-E130 ◽  
Author(s):  
Zumrut T. Demirozu ◽  
Andre Critsinelis ◽  
William E. Cohn ◽  
Rajko Radovancevic ◽  
Jonathan Ho ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Advanced Age ◽  
Circulatory Support ◽  
Assist Device ◽  
Heartmate Ii ◽  
Ventricular Assist ◽  
Left Ventricular Assist

Background: Advanced age is a relative contraindication for heart transplantation, but no age cutoff has been defined for patients receiving mechanical circulatory support. Methods: Between November 1, 2003 and November 1, 2012, we implanted the HeartMate II (HMII) left ventricular assist device (LVAD) in 319 patients. One hundred seven patients (89 men, 18 women) were over 60 years old (mean, 66 ± 4 years; range, 61-78 years) and received the HMII as a bridge to transplantation (n = 45) or as destination therapy (n = 62). We evaluated their experience by performing a retrospective analysis. Results: Seventy-two patients had ischemic cardiomyopathy, and 34 had idiopathic cardiomyopathy. Three patients (2.8%) already had a HeartMate XVE LVAD; 54 (50.5%) were receiving intra-aortic balloon pump support; 52 (48.6%) had undergone a previous cardiac procedure; and 9 (8.4%) had received renal replacement therapy (RRT) (continuous venovenous hemofiltration, hemodialysis, or both) before HMII implantation. The median duration of HMII support was 313 days (range, 1-3339 days). After device implantation, 36 patients (33.6%) had gastrointestinal bleeding, 24 (23%) required RRT, 18 (17.5%) had ventricular arrhythmias, and 24 (22.4%) had LVAD-related infections, and 9 (8.4%) had right ventricular failure requiring mechanical support, and 28 (26.2%) had neurologic complications. The actual survival rate was 69% at 6 months, 63% at 1 year, and 54% at 2 years. Eighty-one patients died; 9 are still receiving HMII support; and 17 are alive after heart transplantation. Conclusions: Older patients can benefit from LVAD therapy, and advanced age should not preclude LVAD implantation.

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