scholarly journals Durable Continuous-Flow Mechanical Circulatory Support: State of the Art

Hearts ◽  
2021 ◽  
Vol 2 (1) ◽  
pp. 127-138
Author(s):  
Antonio Loforte ◽  
Luca Botta ◽  
Silvia Boschi ◽  
Gregorio Gliozzi ◽  
Giulio Giovanni Cavalli ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Continuous Flow ◽  
Mechanical Circulatory Support ◽  
State Of The Art ◽  
Ease Of Use ◽  
Circulatory Support ◽  
Pulse Modulation ◽  
Ventricular Assist ◽  
Old Patients ◽  
Number Of Patients

Implantable mechanical circulatory support (MCS) systems for ventricular assist device (VAD) therapy have emerged as an important strategy due to a shortage of donor organs for heart transplantation. A growing number of patients are receiving permanent assist devices, while fewer are undergoing heart transplantation (Htx). Continuous-flow (CF) pumps, as devices that can be permanently implanted, show promise for the treatment of both young and old patients with heart failure (HF). Further improvement of these devices will decrease adverse events, enable pulse modulation of continuous blood flow, and improve automatic remote monitoring. Ease of use for patients could also be improved. We herein report on the current state of the art regarding implantable CF pumps for use as MCS systems in the treatment of advanced refractory HF.

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.

Abstract WMP66: Cerebrovascular Hemodynamics of Mechanical Circulatory Support Device Patients

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Kara R Melmed ◽  
Konrad H Shlick ◽  
Brenda Rinsky ◽  
Shlee S Song ◽  
Patrick D Lyden
Keyword(s):  
Continuous Flow ◽  
Mechanical Circulatory Support ◽  
Left Ventricular ◽  
Total Artificial Heart ◽  
Circulatory Support ◽  
Normative Values ◽  
Mean Flow ◽  
Mean Velocity ◽  
Ventricular Assist ◽  
Cerebrovascular Hemodynamics

Background: Multiple types of mechanical circulatory support (MCS) devices are commonly used in heart failure patients. These devices carry risk for neurologic complications, specifically cardioembolic stroke. Alterations in blood flow play a role in the pathophysiology, however there is limited data regarding cerebrovascular hemodynamics in MCS patients. We used transcranial Doppler (TCD) to define hemodynamics of commonly used MCS devices. Methods: We retrospectively examined charts from 2/2013 through 6/2016 for patients with MCS who underwent TCD, and obtained the following: peak systolic,end-diastolic velocities, mean flow velocities, pulsatility indices (PI) and number of high-intensity transient signals (HITS). Waveform morphologies were compared between devices. Results: Of 1,796 TCDs studies screened, 62 TCD studies were from 32 MCS patients. Of these, 21 were on extracorporeal membrane oxygenation (ECMO), 15 had a left ventricular assist device (LVAD), 18 had total artificial heart (TAH), and 2 had intra-aortic balloon pumps (IABP). Waveforms in patients supported by ECMO demonstrated continuous flow without clear systolic peaks. The averaged mean MCA velocity was 57.57 (SD= 21.00) cm/sec and mean PI is 0.35 (0.17). LVAD averaged mean MCA velocity was 57.57 (14.38) cm/sec and mean PI of 0.45 (0.28). PIs were low in patients with continuous-flow LVADs. Impella patients had morphologically distinct pulsatile waveforms compared to other types of VADs. IABP had averaged mean velocity of 56.21 (14.78) cm/sec and mean PI of 0.77 (0.15). These waveforms demonstrated pronounced diastolic upstrokes not present in other devices. In TAH patients, mean MCA velocity was 73.69 (33.00) cm/sec and PI of 0.86 (0.40). Emboli detection was performed in 46 studies, and HITS were detected in 29 (63%). Of these 15 (51%) were administered 100% oxygen which suppressed >50% HITS in 10 (67%) patients. Conclusion: Patients supported by MCS devices produce unique and characteristic waveforms on TCD studies. Further studies will describe normative values in this special population. HITS were not universally present and intermittently suppressible by oxygen, suggesting some may be gaseous in nature. Risk of stroke in patients with MCS and HITS is under study.

scholarly journals Haemolysis induced by mechanical circulatory support devices: unsolved problems

Perfusion ◽  
2020 ◽  
Vol 35 (6) ◽  
pp. 474-483
Author(s):  
Inge Köhne
Keyword(s):  
Shear Stress ◽  
Continuous Flow ◽  
Mechanical Circulatory Support ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Ventricular Assist ◽  
Theoretical Approaches ◽  
Blood Pumps ◽  
Mechanical Circulatory Support Devices ◽  
Support Devices

Since the use of continuous flow blood pumps as ventricular assist devices is standard, the problems with haemolysis have increased. It is mainly induced by shear stress affecting the erythrocyte membrane. There are many investigations about haemolysis in laminar and turbulent blood flow. The results defined as threshold levels for the damage of erythrocytes depend on the exposure time of the shear stress, but they are very different, depending on the used experimental methods or the calculation strategy. Here, the results are resumed and shown in curves. Different models for the calculation of the strengths of erythrocytes are discussed. There are few results reported about tests of haemolysis in blood pumps, but some theoretical approaches for the design of continuous flow blood pumps according to low haemolysis have been investigated within the last years.

scholarly journals Mechanical Circulatory Support in Advanced Heart Failure

2021 ◽  
pp. 263246362110327
Author(s):  
Sonali Arora ◽  
Auras R. Atreya
Keyword(s):  
Heart Failure ◽  
Cardiogenic Shock ◽  
Heart Transplantation ◽  
Medical Therapy ◽  
Mechanical Circulatory Support ◽  
Advanced Heart Failure ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Ventricular Assist ◽  
Advanced Therapies

Advanced heart failure (HF) with persistent and progressive clinical decline despite maximal medical therapy portends a high mortality in the absence of advanced therapies, such as ventricular assist devices or heart transplantation. A subset of these advanced HF patients deteriorates into refractory cardiogenic shock, that is challenging to manage with vasoactive agents alone. Temporary mechanical circulatory support (MCS) device options have evolved over the years and provide a viable option to rescue and rest the myocardium of patients in cardiogenic shock. The goal of such therapy is to serve as bridge to recovery, or more often, a bridge to durable advanced therapies. For those patients with progressive advanced HF despite extensive medical therapy, durable MCS devices (ventricular assist devices) are available when heart transplantation is not feasible. In this article, we review currently available temporary and durable MCS devices, with a focus on their hemodynamic profiles, to inform optimal device selection for patients with advanced HF.

Sign in / Sign up

Export Citation Format

Share Document