Ventricular Assist Device Research Articles

Assessing the information needs of patients implanted with a left ventricular assist device via analysis of social media forums

Abstract Background Left Ventricular Assist Devices (LVADs) serve as a feasible treatment alternative for patients with end-stage heart failure who do not respond sufficiently to maximal medical therapy. An increasing number of individuals with end-stage heart failure, both pre- and post-LVAD implantation, are utilizing social media to find medical information and peer support. Purpose The objective of this study was to identify unmet education and information needs of patients with LVAD through social media interactions. Methods In this research, information was gathered from the forum section of the website MyLVAD.com through an automated extraction technique. We conducted an anonymous collection and analysis of a dataset from MyLVAD.com, which comprised 459 forum threads and 3886 messages across the entire forum, contributed by 945 unique users. To establish a matrix addressing existing information and educational needs, we examined 867 posts and conversations that contained questions and inquiries, ultimately identifying a total of 435 concrete questions. A series of categorization matrices were developed and updated to facilitate the discovery of new categories. Results Numerous information gaps and unanswered questions were discovered in relation to the following areas: clothing, complications/adverse events, LVAD pros and cons, self-care, therapy, and recent LVAD implantation. Among the 435 questions, 216 (49.7%) questions had a primary focus on self-care for patients with LVAD, including subjects such managing the driveline site, understanding equipment functionality, and adapting lifestyle habits to ensure safety and health while living with an LVAD. Two other major question categories emerged: those regarding complications/adverse effects, comprising 80 questions (18.4%), and those discussing the pros and cons of LVAD, with 67 questions, accounting for 15.4%. Conclusion The social media data retrieved from MyLVAD.com is the first to be used to assess the unmet needs and knowledge gaps among patients implanted with LVAD and develop categories to describe LVAD patient knowledge and information needs. Unlike investigator-generated data, social media data reflect the natural and organic conversation between patients, untainted by investigator agendas or biases. Social media data can enhance our understanding of patient information deficiencies. This can lead to the creation of materials specifically aimed at fulfilling unaddressed educational requirements.Unmet LVAD patients information needs

Treatment paths and resources used for patients with a left ventricular assist device: an Italian survey

Abstract Background The number of people with end-stage Heart Failure implanted with a Left Ventricular Assist Device (LVAD) is constantly increasing, demanding hospitals to develop new and specific treatment paths. No previous studies described services and treatments available for these patients at national level. Knowing how hospitals organize their resources in order to meet patients’ need would be useful to standardize and improve care offered to this population. Purpose To investigate how Italian hospitals that are reference centers for people with LVAD organize treatment paths and resources for these patients. Methods A cross-sectional observational study was conducted. A survey including questions about all the relevant aspects of treatment paths for people with LVAD was created and validated by 4 LVAD experts (2 nurses and 2 physicians) from 2 different hospitals. The survey was then administered to the 22 (> 95%) of the Italian hospitals that are reference centers for people with LVAD. Results Results show a picture of how treatment paths and resources for people with LVAD are organized in Italy nowadays. Nurses play a pivotal role in the multi-professional team that takes care of these patients, being often acknowledged as LVAD Coordinator (case-manager) and being involved in crucial activities such as health education, monitoring of health conditions before and after dismission, and improving patients’ empowerment. Health education is recognized as an essential activity, but many hospitals still struggle to organize it according to patients’ needs and not organizational ones. Palliative care, even if recognized by the most recent guidelines as a crucial element of treatment options in people with LVAD, is a need that remains often unmet. Conclusion The growing number of people with LVAD requires an effort for re-organizing resources and treatment paths for them. There is a great need for integrating palliative care in the several treatment options for these patients. Nurses play a pivotal role in all stages of the treatment paths, and should be provided with specific education, as the whole multi-professional team.

Influence of different electrode placement patterns on electromagnetic interference generated by Left Ventricular Assist Devices (LVADs) during electrocardiogram performance

Abstract Background Heart failure (HF), with an incidence of approximately 3/1000 person-years, often progresses to advanced stages where symptoms persist despite treatment. In such cases, mechanical circulatory assist devices, particularly left ventricular assist devices (LVADs) in ambulatory patients, enhance survival and quality of life. These LVADs generate electromagnetic interference, resulting in noise artefacts in conventional electrocardiograms (ECGs). The conventional ECG should be configured with a low-pass filter of 150 Hz and a high-pass filter of 0.05 Hz, as recommended by the American Heart Association/American College of Cardiology/Heart Rhythm Society. LVADs, such as the HeartMate 3 (Abbott®), typically operate at a rotational speed of 5000 to 6000 rpm, corresponding to oscillatory frequencies of 83.3 to 100 Hz. Objective To assess the impact of various surface electrode placement strategies and modifications to the low-pass filter on the electromagnetic interference produced by LVADs. Methods We conducted an observational study involving seven patients with HeartMate 3 adjusted to various rotational speeds (refer to Table 1). Three distinct electrode placement schemes (AHA, Mason Likar, and modified Torso) were employed for the frontal plane leads. The horizontal plane leads remained unmodified. Each patient underwent a total of 6 ECGs, corresponding to each of the aforementioned schemes. ECG recordings were performed using a high-pass filter set at 0.05 Hz and a low-pass filter set at 150 Hz. Additionally, a set of ECGs was obtained by modifying the low-pass filter to 40 Hz for further analysis. Results Figure 1 displays ECGs obtained from a male with a HeartMate 3 operating at 4600 rpm or 76.6 Hz. This device employs an algorithm to generate an "artificial pulse" by cyclically accelerating and decelerating the pump speed by 2000 rpm every 2 seconds, resulting in rotational speeds of 2600 rpm and 6600 rpm (43.3 Hz and 110 Hz, respectively). No specific placement scheme demonstrated consistent noise reduction across all cases, likely due to inter-individual variability resulting from factors such as the final position of the LVAD the rpm in each case, and the thoracic impedance of each patient. However, the modification of the low-pass filter to 40 Hz yielded a noteworthy improvement in noise reduction across all cases. In our limited sample, this adjustment did not pose issues for ECG interpretation. Nevertheless, it is essential to acknowledge that excessively low filter settings may not only eliminate noise but also potentially discard clinically relevant high-frequency signals (e.g., pacemaker spikes, large amplitude Rs, QRS notches). Conclusions Individualizing the electrode placement scheme is crucial for minimizing noise generated by LVADs. The adjustment of the low-pass filter to 40 Hz could generally prove beneficial in reducing artifact generation, despite the clinical limitations it may entail.

Re-imagining the future state of the ventricular assist device controller interface through human-centered design.

Ventricular assist devices (VADs) are effective therapy for patients with end-stage heart failure. Current VAD controllers offer improved interactivity, yet limitations of the visual, tactile, and auditory interface persist that impact patient experience and quality of life (QoL). This study explores how VAD controllers can be redesigned using a human-centered design approach to enhance the emotional and functional experience of the device for patients. VAD patients (n = 21), caregivers (n = 4) and healthcare practitioners (n = 24) were interviewed to uncover design opportunities. From this, a series of realistic scenarios to design for emerged. A "design by analogy" method took inspiration from existing consumer products to ideate new functionality for the VAD wearable system, creating concepts for a controller interface and paired wearable device. An additional 15 patients and 2 caregivers were engaged to explore current VAD controller experiences and evaluate the future-state concepts. This research validated the need for increased automation and emergency functionality in VAD controllers, including remote monitoring of data, accurate communication of battery status, and automated medical alerts for critical device alarms. "Manage my health," "Feeling normal," "Social belonging," "Feeling safe," and "Sense of control" emerged as key patient concerns to be met by future VAD controller designs. The study demonstrated an innovative and relevant approach to improve usability of future VAD peripherals. By considering both emotional and functional perspectives in the design of lifesaving medical devices such as VADs, device manufacturers can uncover new opportunities to improve patient QoL through improved user experiences.

Pulsatility of Pulmonary Artery Waveforms Before and After Left Ventricular Assist Device Is Associated With Right Ventricular Failure.

Pulsatility of Pulmonary Artery Waveforms Before and After Left Ventricular Assist Device Is Associated With Right Ventricular Failure.

Mortality in Recipients of Durable Left Ventricular Assist Devices Undergoing Ventricular Tachycardia Ablation

BackgroundLeft ventricular assist device (LVAD) recipients have a higher incidence of ventricular tachycardia (VT). However, the role of VT ablation in this population is not well-established. ObjectivesThis single-center retrospective cohort study sought to examine the impact of post-LVAD implant VT ablation on survival. MethodsThis retrospective study examined a cohort of patients that underwent LVAD implantation at Baylor St. Luke’s Medical Center and Texas Heart Institute between January 2011 and January 2021. All-cause estimated mortality was compared across LVAD recipients based on the incidence of VT, timing of VT onset, and the occurrence and timing of VT ablation utilizing Kaplan-Meier survival analysis and Cox proportional hazards models. ResultsPost-implant VT occurred in 53% of 575 LVAD recipients. Higher mortality was seen among patients with post-implant VT within a year of implantation (HR: 1.62 [95% CI: 1.15-2.27]). Among this cohort, patients who were treated with a catheter ablation had superior survival compared with patients treated with medical therapy alone for the 45 months following VT onset (HR: 0.48 [95% CI: 0.26-0.89]). Moreover, performance of an ablation in this population aligned mortality rates with those who did not experience post-implant VT (HR: 1.18 [95% CI: 0.71-1.98]). ConclusionsVT occurrence within 1 year of LVAD implantation was associated with worse survival. However, performance of VT ablation in this population was correlated with improved survival compared with medical management alone. Among patients with refractory VT, catheter ablation aligned survival with other LVAD participants without post-implant VT. Catheter ablation of VT is associated with improved survival in LVAD recipients, but further prospective randomized studies are needed to compare VT ablation to medical management in LVAD recipients.

Monitoring Berlin Heart EXCOR by computer vision: Apreliminary implementation and evaluation.

EXCOR Pediatric is one of the most commonly used ventricular assist devices (VAD) for small children; it requires visual inspection of the diaphragm movement to assess its operating status. Although this visual inspection can only be performed by trained medical professionals, it can also be attempted by the recent advances in computer vision technology. Movement of the diaphragm in the operating EXCOR VAD was recorded as movies and annotated frame-by-frame in three classes according to the state of the diaphragm: "fill," "mid," and "empty." Three models, MobileNetV3, EfficientNetV2, and MobileViT, were trained using the frames, and their performance was evaluated based on the accuracy and area under the receiver operating characteristic curve (AROC). A total of 152 movies were available from two participants. Only the 10 mL pumps were used. Ninety-eight movies were used for annotation and frame extraction, and 7949 frames per class were included in the analysis. The macro-average accuracies of the three models were 0.88, 0.91, and 0.93, and the AROC were 0.99, 0.98, and 0.99 for MobileNetV3, EfficientNetV2, and MobileViT, respectively. Image recognition models based on lightweight deep neural networks could detect the diaphragm state of EXCOR VAD with sufficient accuracy, although there were limited variations in the dataset. This suggests the potential of computer vision for the automated monitoring of the EXCOR diaphragm position.

Impact of Diabetes and Glycemia on Cardiac Improvement and Adverse Events Following Mechanical Circulatory Support.

Type 2 diabetes is prevalent in cardiovascular disease and contributes to excess morbidity and mortality. We sought to investigate the effect of glycemia on functional cardiac improvement, morbidity, and mortality in durable left ventricular assist device (LVAD) recipients. Consecutive patients with an LVAD were prospectively evaluated (n=531). After excluding patients missing pre-LVAD glycated hemoglobin (HbA1c) measurements or having inadequate post-LVAD follow-up, 375 patients were studied. To assess functional cardiac improvement, we used absolute left ventricular ejection fraction change (ΔLVEF: LVEF post-LVAD-LVEF pre-LVAD). We quantified the association of pre-LVAD HbA1c with ΔLVEF as the primary outcome, and all-cause mortality and LVAD-related adverse event rates (ischemic stroke/transient ischemic attack, intracerebral hemorrhage, gastrointestinal bleeding, LVAD-related infection, device thrombosis) as secondary outcomes. Last, we assessed HbA1c differences pre- and post-LVAD. Patients with type 2 diabetes were older, more likely men suffering ischemic cardiomyopathy, and had longer heart failure duration. Pre-LVAD HbA1c was inversely associated with ΔLVEF in patients with nonischemic cardiomyopathy but not in those with ischemic cardiomyopathy, after adjusting for age, sex, heart failure duration, and left ventricular end-diastolic diameter. Pre-LVAD HbA1c was not associated with all-cause mortality, but higher pre-LVAD HbA1c was shown to increase the risk of intracerebral hemorrhage, LVAD-related infection, and device thrombosis by 3 years on LVAD support (P<0.05 for all). HbA1c decreased from 6.68±1.52% pre-LVAD to 6.11±1.33% post-LVAD (P<0.001). Type 2 diabetes and pre-LVAD glycemia modify the potential for functional cardiac improvement and the risk for adverse events on LVAD support. The degree and duration of pre-LVAD glycemic control optimization to favorably affect these outcomes warrants further investigation.

HeartMate 3 for Heart Failure with Preserved Ejection Fraction: In Vitro Hemodynamic Evaluation and Anatomical Fitting.

Heart failure with preserved ejection fraction (HFpEF) constitutes approximately 50% of heart failure (HF) cases, and encompasses different phenotypes. Among these, most patients with HFpEF exhibit structural heart changes, often with smaller left ventricular cavities, which pose challenges for utilizing ventricular assist devices (VADs). A left atrial to aortic (LA-Ao) VAD configuration could address these challenges, potentially enhancing patient quality of life by lowering elevated mean left atrial pressure (MLAP). This study assessed the anatomical compatibility and left atrial unloading capacity using a simulated VAD-supported HFpEF patient. A HeartMate3-supported HFpEF patient in an LA-Ao configuration was simulated using a cardiovascular simulator. Hemodynamic parameters were recorded during rest and exercise at seven pump flow rates. Computed tomography scans of 14 HFpEF (NYHA II-III) and six heart failure with reduced ejection fraction patients were analysed for anatomical comparisons. HFpEF models were independently assessed for virtual anatomical fit with the HM3 in the LA-Ao configuration. Baseline MLAP was reduced from 15 to 11mmHg with the addition of 1L/min HM3 support in the rest condition. In an exercise simulation, 6L/min of HM3 support was required to reduce the MLAP from 29 to 16mmHg. The HM3 successfully accommodated six HFpEF patients without causing interference with other cardiac structures, whereas it caused impingement ranging from 4 to 14mm in the remaining patients. This study demonstrated that the HM3 in an LA-Ao configuration may be suitable for unloading the left atrium and relieving pulmonary congestion in some HFpEF patients where size-related limitations can be addressed through pre-surgical anatomical fit analysis.

A case of truncus arteriosus with severe heart failure and pulmonary stenosis: bridge to transplant candidacy with surgical correction and a ventricular-assist device.

Ventricular-assist device therapy for small patients with congenital heart disease is challenging due to its complex anatomy and hemodynamics. We describe a 3-year-old patient with heart failure with truncus arteriosus in the palliative stage. The patient underwent palliative right ventricular outflow tract reconstruction following bilateral pulmonary artery banding. At 6months of age, the patient developed severe truncal valve regurgitation and left ventricular dysfunction. Emergent truncal valve replacement with a mechanical valve was performed, but left ventricular dysfunction persisted. At 3years of age, the patient developed acute progression of heart failure triggered by influenza infection. The patient was intubated and transferred to our center to determine the indication for heart transplantation. On the second day after admission, signs of multiorgan failure appeared. Emergent ventricular-assist device implantation for both ventricles was performed with truncal valve closure, ventricular septal defect closure, atrial septal defect closure, and re-right ventricular outflow tract reconstruction. The right ventricular-assist device was successfully removed on the seventh postoperative day. Due to the small pulmonary arteries, severe pulmonary stenosis persisted after ventricular-assist device implantation, but it gradually improved with multiple pulmonary angioplasties. The patient was registered in the Japanese organ transplant network and is awaiting a donor organ in a stable condition.

Contemporary Role of Positron Emission Tomography (PET) in Endocarditis: A Narrative Review.

Endocarditis, a serious infectious disease, remains a diagnostic challenge in contemporary clinical practice. The advent of advanced imaging modalities has contributed significantly to the improved understanding and management of this complex disease. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) imaging has shown remarkable potential in improving the diagnostic accuracy of endocarditis. In the update of the Modified Duke Criteria, in 2023, The International Society for Cardiovascular Infectious Diseases (ISCVID) Working Group recognized specific 18F-FDG PET/CT findings as a major diagnostic criterion, particularly in patient with prosthetic valve endocarditis. The ability of PET to visualize metabolic activity allows for the identification of infective foci and could differentiate between infective and non-infective processes. This review examines the clinical utility of PET in differentiating infective endocarditis from other cardiovascular pathologies, highlighting its sensitivity and specificity in detecting native and prosthetic valve infections, including patients with transcatheter aortic valve implantation (TAVI), cardiac implantable devices (CIEDs), and left ventricular assistance devices (LVAD). Also, practical aspects and indications are illustrated to optimize the quality of imaging and reduce potential false positive results. In conclusion, the current use of PET in endocarditis has become a valuable diagnostic tool; as technological advances continue, PET will play an increasingly important role in the multidisciplinary approach to the management of endocarditis.

Changes in waiting time, need for mechanical circulatory support and outcomes in paediatric heart transplant recipients.

Heart transplantation is a well-established treatment for end-stage heart failure in paediatric patients, demonstrating excellent long-term outcomes. This retrospective study analyses 35years of data on 244 paediatric recipients (<18years) at a single institution from 1986 to 2022. The analysis explores changes in diagnoses, survival, waiting times and mechanical circulatory support (MCS) over three decades (1991-2000, 2001-2010 and 2011-2020). Survival outcomes significantly improved over the study period, with 1-year survival rates increasing from 79.3% (1991-2000) to 92.3% (2011-2020, P=0.041). The median overall survival was 18.0years, and median conditional survival to 1year post-transplant was 20.9years. Survival differences were noted among age groups, with infants under 1year of age experiencing higher early mortality, and adolescents (aged 11-17years) facing increased long-term risks, possibly linked to adult donor characteristics. Waiting times for heart transplantation increased, especially for younger age groups (0-5 and 6-10years), reflecting the growing demand for donor organs. The use of MCS, including ventricular assist devices (VAD), surged, with 67% of recipients in the most recent decade receiving pre-transplant VAD support. Importantly, despite prolonged waiting times and increased VAD use, overall survival continued to be favourable. Early and long-term results after paediatric heart transplantation have been continuously improving over the past decades. Despite an increased demand for donor organs and the growing reliance on VAD as bridge to transplantation, post-transplantation survival is not compromised.

Pediatric continuous-flow total artificial heart with rotor axial position tracking technology: First report of in vivo assessment

BackgroundThe pediatric continuous-flow total artificial heart (P-CFTAH) is a novel double-ended centrifugal pump designed with the intent to provide circulatory support for pediatric heart failure. ObjectivesTo enable continuous monitoring of pump hemodynamics, Hall effect sensors (HES) were embedded inside the P-CFTAH design to track both axial movement and position of the pump rotor post-implantation. Herein, we report an early in vivo evaluation of the P-CFTAH with HES, implanted in small-sized ovine models. MethodsFive healthy lambs were used for the P-CFTAH implantation via a full median sternotomy and cardiopulmonary bypass support. Successful evaluation of the P-CFTAH was achieved in four out of five (n = 4, 20.9 ± 1.3 kg). The hemodynamics and operating conditions were continuously recorded with varying pump speeds (2,800-5,000 rpm), systemic/pulmonary vascular resistance ratio, and high- and low-volume conditions. Among the four cases, P-CFTAH with HES embedded in the rotor was used in two cases. ResultsAll surgical procedures were uneventful, and the optimal anatomical fit of the pump was shown in the chest. Differences between the left and right atrial pressures were mostly maintained within the intended limit of ± 10 mm Hg throughout the design range of systemic and pulmonary vascular resistance. The HES accurately traced the rotor position, showing a positive correlation with atrial pressure differences. ConclusionsThe findings suggest that the P-CFTAH has the potential to provide self-balancing circulatory support for pediatric heart failure patients. The study contributes to the development of a pediatric-sized total artificial heart with improved monitoring.

Oral amiodarone and propranolol in maintenance therapy of postimplantation tachycardia: An observational study.

Left ventricular assist devices (LVADs) are widely used as end-stage therapy in patients with advanced heart failure, whereas implantation increases the risks of development of sustained ventricular tachycardia at the later postimplantation stage. Therefore, this study aimed to evaluate the clinical efficacy of orally administered amiodarone and propranolol in 3 patients with ventricular tachycardia (VT) after LVAD implantation who were resistant to initial anti-antiarrhythmic drugs. This retrospective cohort study consisted of the initial evaluation of the clinical data of 14 adult patients who underwent implantation of LVAD between January 2019 and March 2021. A total of 3 patients with resistant VT were finally included. In all cases, the patients were initially administered amiodarone in the different doses intravenously to stabilize the critical condition, whereas its oral form along with that of propranolol was used as maintenance therapy in the first 2 cases. In the third case, amiodarone was withdrawn because of the risk of development of hyperthyroidism, while oral propranolol was used in the treatment. The assessment in the 16-month follow-up period after discharge did not show presence of non-sustained and sustained VT in all 3 cases. In the ventricular arrhythmia-free group, the total mortality rate within the follow-up period was 11.1 ± 7.78 months in the 3 patients. We suggest that maintenance oral therapy of propranolol and amiodarone can significantly decrease the risks of complications in patients with VT after implantation of ventricular assist device in the long term.

Concomitant tricuspid valve surgery in patients with significant tricuspid regurgitation undergoing left ventricular assist device implantation: A systematic review and meta-analysis.

Significant tricuspid regurgitation (TR) is a predictor of right heart failure (RHF) and increased mortality following left ventricular assist device (LVAD) implantation, however the benefit of tricuspid valve surgery (TVS) at the time of LVAD implantation remains unclear. This study compares early and late mortality and RHF outcomes in patients with significant TR undergoing LVAD implantation with and without concomitant TVS. A systematic search of four electronic databases was conducted for studies comparing patients with moderate or severe TR undergoing LVAD implantation with or without concomitant TVS. Meta-analysis was performed for primary outcomes of early and late mortality and RHF. Secondary outcomes included rate of stroke, renal failure, hospital and ICU length of stay. An overall survival curve was constructed using aggregated, reconstructed individual patient data from Kaplan-Meier (KM) curves. Nine studies included 575 patients that underwent isolated LVAD and 308 patients whom received concomitant TVS. Both groups had similar rates of severe TR (46.5% vs. 45.6%). There was no significant difference seen in risk of early mortality (RR 0.90; 95% CI, 0.57-1.42; p = 0.64; I2 = 0%) or early RHF (RR 0.82; 95% CI, 0.66-1.19; p = 0.41; I2 = 57) and late outcomes remained comparable between both groups. The aggregated KM curve showed isolated LVAD to be associated with overall increased survival (HR 1.42; 95% CI, 1.05-1.93; p = 0.023). Undergoing concomitant TVS did not display increased benefit in terms of early or late mortality and RHF in patients with preoperative significant TR. Further data to evaluate the benefit of concomitant TVS stratified by TR severity or by other predictors of RHF will be beneficial.

Recognition of psychological comorbidity and psychotherapeutic treatment status of ventricular assist device patients.

Due to its high impact on quality of life and mental health, close monitoring and often psychotherapy is recommended for patients with a ventricular assist device (VAD). This study investigates the psychological comorbidity and the corresponding psychotherapeutic treatment situation of VAD patients. Special attention is also given to the professional perspective VAD team (assistant and senior cardiologists and specialized nurses). We conducted a cross-sectional observational study. Data from 50 VAD patients (mean age = 53.52, standard deviation = 13.82 years, 84.0% male) and their VAD team were analyzed. The presence of a psychological disorder was evaluated by structured clinical interviews for DSM-IV (SCID-I-Interviews). Patients answered a questionnaire regarding their current psychotherapeutic treatment status and their attitude towards psychotherapy. The VAD team answered a questionnaire about the patients' needs for psychotherapy and indicated whether they addressed this topic with the patient. Data were analyzed descriptively, by analysis of variance and t-test. A total of 58% of VAD patients suffered from at least one significant psychological disorder, 79.3% of those were not in psychotherapy. The VAD team could not identify the patients who suffered from a psychological disorder (F = 1.90; p = 0.18). They perceived more need for psychotherapy than they addressed with their patients (T = 3.39; p < 0.001). While there is a high psychological morbidity among VAD patients, only few receive psychotherapy. Psychological comorbidity is not easily detected by the VAD team. Standardized psychosocial care could be implemented by regular psychological assessments and further information of patients and their VAD teams.

Impact of Dietary Vitamin K Intake on Anticoagulation Therapy in Patients With Left Ventricular Assist Device During the 2018 Osaka Earthquake.

Background: The 2018 Osaka earthquake caused severe damage to the National Cerebral and Cardiovascular Center, and the interruption to the delivery of hospital food in particular had a significant effect on patients with left ventricular assist devices (LVAD). Methods and Results: We retrospectively assessed 10 patients who had been provided with emergency rations on the day of earthquake and the next day for breakfast. Catered foods were provided thereafter. Vitamin K content was largely reduced due to emergency rations; the prothrombin time-international normalized ratio (PT-INR) on day 2 was significantly higher than on day 1. Conclusions: Close monitoring of PT-INR and assessing vitamin K content may be important for preventing complications in patients with a LVAD during a disaster.

Clinical outcomes of HeartMate 3 left ventricular assist device support with a Bridge to Transplant vs a Destination Therapy strategy: a single-centre retrospective cohort.

Real-world outcomes with the HeartMate3 left ventricular assist device (LVAD) depending on whether it's a bridge to transplantation (BTT) or destination therapy (DT) are poorly studied. We aimed to compare the profile and clinical outcomes of patients supported with HeartMate3 according to a BTT or a DT pre-implantation strategy. All patients consecutively implanted with HeartMate3 at our centre (University Hospital of Lausanne, Switzerland) in 2015-2022 were analysed in a retrospective observational study. Indications for HeartMate3 implantation were advanced heart failure despite optimal medical treatment. Patients were treated with a vitamin K antagonist anticoagulant combined with antiplatelet therapy after HeartMate 3 implantation and were followed up monthly at our institution. Among 71 patients implanted with HeartMate3 between 2015 and 2022, 51 (71.8%) were implanted as a BTT and 20 (28.2%) as DT. Their median age was 58 (IQR: 52-69) years and 84% of patients were classified as INTERMACS profiles 2-4. The median follow-up duration was 18.3 (IQR: 7.5-33.9) months. Patients in the DT group were older than those in the BTT group (p <0.001) and had more chronic renal failure (p <0.001). They also had a lower 5-year survival rate (mean ± standard error: 87.3 ± 5.6% vs 49.4 ± 15.1%)and more adverse events such as renal dysfunction requiring temporary perioperative dialysis (p = 0.08) or bleeding (p = 0.06). Although patients supported with HeartMate3 have favourable survival, those with LVAD-DT have poorer outcomes. There is a need to better select patients eligible for LVAD-DT in order to limit the burden of adverse events and improve their prognosis.

The Role of Speckle Tracking Echocardiography in the Evaluation of Advanced-Heart-Failure Patients.

Health care is currently showing a fall in heart failure (HF) incidence and prevalence, particularly in developed countries, but with only a subset receiving appropriate therapy to protect the heart against maladaptive processes such as fibrosis and hypertrophy. Appropriate markers of advanced HF remain unidentified, which would help in choosing the most suitable therapy and avoid major compliance problems. Speckle tracking echocardiography (STE) is a good choice, being a non-invasive imaging technique which is able to assess cardiac deformation in a variety of conditions. Several multicenter studies and meta-analyses have demonstrated the clinical application and accuracy of STE in early and late stages of HF, as well as its association with both left ventricular (LV) filling pressures and myocardial oxygen consumption. Furthermore, STE assists in assessing right ventricular free-wall longitudinal strain (RVFWLS), which is a solid predictor of right ventricle failure (RVF) following LV assist device (LVAD) implantation. However, STE is known for its limitations; despite these, it has been shown to explain symptoms and signs and also to be an accurate prognosticator. The aim of this review is to examine the advantages of STE in the early evaluation of myocardial dysfunction and its correlation with right heart catheterization (RHC) parameters, which should have significant clinical relevance in the management of HF patients.

Relationship between the HeartMate Risk Score category on admission and outcome in patients with acute heart failure referred to a cardiac intensive care unit.

The HeartMate Risk Score (HMRS), a simple clinical prediction rule based on the patients' age, albumin, creatinine, and the international normalized ratio of the prothrombin time (PT-INR), is correlated with mortality in the cohort of left ventricular assist device (LVAD) recipients. However, in an aging society, an LAVD is indicated for only a small proportion of patients with acute heart failure (AHF), and whether the HMRS has prognostic implications for unselected patients with AHF is unknown. This study aimed to assess the prognostic value of HMRS categories on admission in patients with AHF. We analyzed 339 hospitalized patients with AHF who had albumin, creatinine, and the PT-INR recorded on admission. The patients were categorized as follows: the High group (HMRS > 2.48, n = 131), Mid group (HMRS of 1.58-2.48, n = 97) group, and Low group (HMRS < 1.58, n = 111). The endpoints of this study were all-cause death and readmission for heart failure (HF). During a median follow-up of 247days, 24 (18.3%) patients died in the High group, 7 (7.2%) died in the Mid group, and 8 (7.2%) died in the Low group. In a multivariable analysis adjusted for highly imbalanced baseline variables, a high HMRS was independently associated with survival, with a hazard ratio of 2.90 (95% confidence interval 1.42-5.96, P = 0.004). With regard to the composite endpoint of all-cause death and readmission for HF, the Mid group had a worse prognosis than the Low group, and the High group had the worst prognosis. A high HMRS on admission is associated with all-cause mortality and readmission for HF, and a mid-HMRS is associated with readmission for HF after AHF hospitalization. The HMRS may be a valid clinical tool to stratify the risk of adverse outcomes after hospitalization in unselected patients with AHF.