Browsing by Subject "Heart-assist devices"

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    Dendritic Cell Therapy in Transplantation, Phenotype Governs Destination and Function
    (Lippincott, Williams & Wilkins, 2018-10) Samy, Kannan P.; Brennan, Todd V.; Surgery, School of Medicine
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    Social Determinants of Health and Rates of Implantation for Patients Considering Destination Therapy Left Ventricular Assist Device
    (Elsevier, 2021) Flint, Kelsey; Chaussee, Erin L.; Henderson, Kamal; Breathett, Khadijah; Khazanie, Prateeti; Thompson, Jocelyn S.; McIlvennan, Colleen K.; LaRue, Shane J.; Matlock, Daniel D.; Allen, Larry A.; Medicine, School of Medicine
    Background: A left ventricular assist device (LVAD) is a treatment option available to select patients with advanced heart failure. However, there are important social determinants of health that can play a role in determining patients' outcomes after device placement. Methods and results: We leveraged the DECIDE-LVAD Trial to assess social determinants of health-relationship status, household income, race/ethnicity, educational attainment, and health insurance-at the time of evaluation, and their association with rate of LVAD placement in the subsequent year. About a quarter of patients were unpartnered (i.e., single/divorced/widowed/separated; n = 55 [26%]). A similar proportion had a household income of less than $20,000 per year (n = 50 [24%]). Few patients were other race (n = 39 [18%]), had less than a high school education (n = 14 [6.6%]), or had Medicaid as their primary payor (n = 17 [8.4%]). LVAD implantation was significantly lower among patients who were unpartnered compared with patients who were married or partnered. LVAD implantation was not associated with income, race, educational attainment or insurance status. Conclusions: Our data from diverse LVAD centers at U.S. private and academic hospitals found that, among a broad sample of patients being evaluated for LVAD, married or partnered status was favorably associated with LVAD implantation, but other social determinants of health were not. Future research and policy changes should consider novel interventions for improving access to LVAD implantation for patients with inadequate social support.
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    Twelfth Interagency Registry for Mechanically Assisted Circulatory Support Report: Readmissions after LVAD
    (Elsevier, 2022) Shah, Palak; Yuzefpolskaya, Melana; Hickey, Gavin W.; Breathett, Khadijah; Wever-Pinzon, Omar; Khue-Ton, Van; Hiesinger, William; Koehl, Devin; Kirklin, James K.; Cantor, Ryan S.; Jacobs, Jeffrey P.; Habib, Robert H.; Pagani, Francis D.; Goldstein, Daniel J.; Medicine, School of Medicine
    The twelfth annual report from The Society of Thoracic Surgeons (STS) Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) highlights outcomes for 26 688 continuous-flow left ventricular assist device (LVAD) patients over the past decade (2011-2020). In 2020, we observed the largest drop in yearly LVAD implant volumes since the registry's inception, which reflects the effects of the COVID-19 pandemic on cardiac surgical volumes in the United States. The 2018 heart transplant allocation policy change in the United States continues to affect LVAD implantation volumes and device strategy, with 78.1% of patients now receiving LVAD implants as destination therapy. Despite an older and sicker patient cohort, survival in the recent era (2016-2020) at 1 and 2 years continues to improve at 82.8% and 74.1%. Patient adverse event profile has also improved in the recent era, with significant reductions in stroke, gastrointestinal bleeding, infection, and device malfunction/pump thrombosis. Finally, we review the burden of readmissions after LVAD implant and highlight an opportunity to improve patient outcomes by reducing this frequent and vexing problem.