Browsing by Subject "Left ventricular assist device"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    Aortic root thrombosis leading to STEMI in a Heartmate 3 patient
    (Springer, 2023-03) Ilonze, Onyedika J.; Torabi, Asad; Guglin, Maya; Saleem, Kashif; Rao, Roopa; Medicine, School of Medicine
    Despite left ventricular assist device (LVAD) therapy becoming established for end-stage heart failure (HF), complications remain. Thromboembolic complications are rare with the newest iteration of LVADs. We managed a case of a continuous-flow LVAD-related thromboembolic event that presented as an acute myocardial infarction. A 64-year-old male who underwent Heartmate III® LVAD implantation had crushing substernal chest pain and ventricular tachycardia with acute anterolateral myocardial infarction on electrocardiogram on post-operative day 9. Echocardiography showed closed aortic valve and mild aortic regurgitation, but CT angiography showed thrombus within the left coronary cusp despite full anticoagulation. Continuous suction of blood from the left ventricle despite pulsatile flow into the ascending aorta resulted in a minimally opening aortic valve and stagnation of blood leading to thrombosis on the coronary cusp. Apart from post-operative ventricular tachycardia and right ventricular failure, he had adequate body size (body surface area 2.13 m2) and no post-operative or coagulopathy which could predispose him to thrombosis. Coronary angiography revealed stable severe three-vessel disease and thrombus in left main and proximal circumflex artery, and he had aspiration thrombectomy, and international normalized ratio target was increased to 3–3.5 with aspirin 325 mg daily. He survived to discharge but died 60 days after LVAD implant with multiple low flow alarms, and cardiac arrest. We review the literature and propose a management algorithm for patients with impaired AV opening and aortic root thrombosis.
  • Thumbnail Image
    Item
    Pulmonary artery dissection in a patient with right-sided mechanical circulatory support and an LVAD
    (Elsevier, 2022-12) Savsani, Parth; Chapa, Jeffrey; Saleem, Kashif; Ballut, Kareem; Ilonze, Onyedika; Guglin, Maya; Rao, Roopa A.; Medicine, School of Medicine
    The use of a left ventricular assist device (LVAD) is an essential treatment option for patients with advanced heart failure, as both a bridge to transplant and a destination therapy. It is important to consider the risks associated with an LVAD, however, as complications can present with a range of severity and chronicity. In the perioperative setting of LVAD implantation, right ventricular failure (RVF) can occur in an estimated 20% of patients. 1 ,2 RVF increases both morbidity and mortality, and it is reported that the 1-year survival rate is 60% in patients requiring biventricular support devices. 1 ,2 Temporary percutaneous right ventricular assist devices (RVAD) can be used until hemodynamic stability is achieved, or until the patient is bridged to a permanent RVAD or cardiac transplantation. In recent years, the TandemLife ProtekDuo (TandemLife, Pittsburg, PA) (TPD) or the CentriMag (Abbott, Chicago, IL) have been introduced as options for temporary right ventricular support. However, temporary RVADs also can cause a variety of complications, including, but not limited to, tricuspid regurgitation, hemolysis, cannula migration, or cerebrovascular insults. 1 ,3 When indicated, patients who require biventricular devices are at much higher risk of complications and adverse events, as compared to those with an LVAD or RVAD alone. Despite the documented risk, temporary RVADs remain one of very few options to treat RVF perioperatively and must be considered.
  • Thumbnail Image
    Item
    Use of a Pulmonary Artery Pressure Sensor to Manage Patients With Left Ventricular Assist Devices
    (Wolters Kluwer, 2023) Thohan, Vinay; Abraham, Jacob; Burdorf, Adam; Sulemanjee, Nasir; Jaski, Brian; Guglin, Maya; Pagani, Francis D.; Vidula, Himabindu; Majure, David T.; Napier, Rebecca; Heywood, Thomas J.; Cogswell, Rebecca; Dirckx, Nicholas; Farrar, David J.; Drakos, Stavros G.; INTELLECT 2-HF Investigators; Medicine, School of Medicine
    Background: Hemodynamic-guided management with a pulmonary artery pressure sensor (CardioMEMS) is effective in reducing heart failure hospitalization in patients with chronic heart failure. This study aims to determine the feasibility and clinical utility of the CardioMEMS heart failure system to manage patients supported with left ventricular assist devices (LVADs). Methods: In this multicenter prospective study, we followed patients with HeartMate II (n=52) or HeartMate 3 (n=49) LVADs and with CardioMEMS PA Sensors and measured pulmonary artery pressure, 6-minute walk distance, quality of life (EQ-5D-5 L scores), and heart failure hospitalization rates through 6 months. Patients were stratified as responders (R) and nonresponders to reductions in pulmonary artery diastolic pressure (PAD). Results: There were significant reductions in PAD from baseline to 6 months in R (21.5-16.5 mm Hg; P<0.001), compared with an increase in NR (18.0-20.3; P=0.002), and there was a significant increase in 6-minute walk distance among R (266 versus 322 meters; P=0.025) compared with no change in nonresponder. Patients who maintained PAD <20 compared with PAD ≥20 mm Hg for more than half the time throughout the study (averaging 15.6 versus 23.3 mm Hg) had a statistically significant lower rate of heart failure hospitalization (12.0% versus 38.9%; P=0.005). Conclusions: Patients with LVAD managed with CardioMEMS with a significant reduction in PAD at 6 months showed improvements in 6-minute walk distance. Maintaining PAD <20 mm Hg was associated with fewer heart failure hospitalizations. Hemodynamic-guided management of patients with LVAD with CardioMEMS is feasible and may result in functional and clinical benefits. Prospective evaluation of ambulatory hemodynamic management in patients with LVAD is warranted.