Mechanical Heart Research Articles

Physiotherapy during and after extracorporeal membrane oxygenation support

Extracorporeal membrane oxygenation (ECMO) is a mechanical heart and/or lung support by a modified heart–lung machine, which enables blood circulation outside the body. The use of ECMO as rescue therapy for the patient in cardiac shock both before and following cardiac surgeries has been increasing over the past two decades. The purpose of this case study is to sensitize the role of the physiotherapist in interventions during and after ECMO in a postoperative cardiac surgery patient. Physical therapy interventions can be provided safely to patients on portable ECMO. These interventions were focused on preventing the negative sequelae of bed rest, improving strength and endurance, preventing ECMO complications as well as improving the level of consciousness and psychological well-being.

Correlation between psychosocial factors and adherence to anticoagulation therapy in patients after mechanical heart valve replacement

Objective To explore the correlation between psychosocial factors and adherence to anticoagulation therapy in patients after mechanical heart valve replacement. Methods Totally 176 patients who received mechanical heart valve replacement and admitted in Taizhou Hospital from January 2016 to December 2017 were selected. The Warfarin awareness and anticoagulation adherence questionnaire, Self-Anxiety Scale (SAS) , Self-Depression Scale (SDS) and Social Support Rating Scale (SSRS) were used to evaluate their adherence to anticoagulation therapy and psychosocial factors. The correlation between their adherence to anticoagulation therapy and psychosocial factors was analyzed. Results The 176 patients showed good adherence to anticoagulation therapy. Their Warfarin awareness, SAS, SDS and SSRS scores averaged (13.27±3.59) , (44.14±8.47) , (45.36±10.11) and (44.38±8.81) , respectively. According to Pearson correlation analysis, the patients' adherence to anticoagulation therapy was positively correlated (P<0.01) with their Warfarin awareness (r=0.621) and social support (r=0.522) and negatively correlated (P<0.01) with anxiety (r=-0.271) and depression (r=-0.319) . Conclusions The adherence to anticoagulation therapy in patients after mechanical heart valve replacement is related to many psychosocial factors. It is positively correlated with their Warfarin awareness and social support and negatively correlated with anxiety and depression. Key words: Heart valve; Anticoagulation medicine; Warfarin; Anxiety; Depression; Social support; Adherence; Replacement

Self-management in patients after mechanical heart valve replacement and the influential factors

Objective To investigate the current status of self-management in patients after mechanical heart valve replacement(MHVR) and the influential factors. Methods The convenience sampling method was used to obtain the sample in Chongqing Province, and 400 participants after MHVR at a month in 3 top three hospitals were recruited (Department of Cardiothoracic Surgery, the First Hospital of Chongqing Medical University. The Second Clinical Medical College of Third Military Medical University. The Third Clinical Medical College of Third Military Medical University). Self-Management Scale for patients after Mechanical Heart Valve Replacement edited by ourselves were used to collect the data. Results The score of patients were 79-119 (96.81 ± 7.86) points. The influential factors were sex, age, education level and the resident manner. Conclusions The self-management level of patients after MHVR is not so bad, the male, advanced age, live with distant relatives or housemaid, low education level's patients' self-management ability are low, the medical workers should strenghen health education in these patients. Key words: Mechanical heart valve replacement; Self-management; Influencing factors

Струйное течение и шум открытого механического двустворчатого сердечного клапана

Струйное течение и шум открытого механического двустворчатого сердечного клапана

Mediating effect of belief about medicine on correlation between social support and adherence to anticoagulation treatment among patients with mechanical heart valve replacement

Objective To explore the relationships among social support, belief about medicine and adherence to anticoagulation treatment, and mediating effect of belief about medicine on the relationship between social support and adherence to anticoagulation treatment among patients with mechanical heart valve replacement. Methods Totally 154 patients were recruited. The social support scale, the modified Chinese Version Morisky Medication Adherence Scale(MMAS-8) and belief about medicine scale were used and the information on patients were collected through clinic and telephone interviews. Results The social support was correlated with belief about medicine (r=0.441, P 0. 05). Conclusion Belief about medicine plays a completely mediating role in the relation between social support and adherence to anticoagulation treatment. Key words: Social support; Mechanical heart valve replacement; Belief about medicine; Adherence to anticoagulation treatment; Mediating effect

Effect of Ramadan Fasting on the International Normalized Ratio in Patients with Mechanical Prosthetic Heart Valves

Background: Maintaining a therapeutic range of International Normalized Ratio (INR) in patients with mechanical prosthetic heart valves is of paramount importance. The effect of religious Fasting and altered lifestyle pattern during the Holy month of Ramadan on the INR stability has not been previously studied in the Saudi population. Objectives: We aimed to evaluate the effect of Ramadan fasting on the INR stability in patients using warfarin anticoagulation for mechanical prosthetic heart valves. Design: Data were extracted retrospectively from a specialized anticoagulation clinic electronic database and were anlysed in a case-control manner, where Ramadan INR of each study subject was compared to his/her own pre-Ramadan INR level. Setting: Prosthetic Valve Anticoagulation Clinic at King Abdul-Aziz Cardiac Center, Riyadh. Materials and methods: Using Point-Of-Care (POC) testing, the first INR level during Ramadan as compared to the average baseline INR readings over the last 3 months before Ramadan. The study was conducted between July 29th and August 20th, 2015, which corresponds to the month of Ramadan, 1436 Hejra Calendar. Several exclusion criteria were applied to minimize the effects of potential confounding factors. Main Outcome measures: Paired t-test was used to detect any statistically significant difference in the INR level between Ramadan and pre-Ramadan readings, in the overall study cohort and among pre-specified study subgroups. Results: One-hundred and fourteen (114) consecutive patients fulfilled the inclusion criteria. Mean age was 48.4±13.6 years and males constituted 58% of cases. Low target (INR: 2.0-3.0) and high target (INR: 2.5-3.5) therapeutic ranges represented 35% and 65% respectively. Mean INR level was 2.81 at baseline and 2.75 during Ramadan with no statistically significant difference between them (P=NS). Achieving the desired target INR level before Ramadan was feasible in 62.5% and 64.8% of the low and high INR target groups respectively. However, maintaining the desired INR level during Ramadan was feasible in 67.5% and 51.3% of the low and high target INR groups respectively (P= 0.07). Duration of anticoagulation, warfarin dose, and adherence scale did not contribute significantly to the primary outcome. Conclusion: Ramadan fasting and its associated lifestyle changes in the Saudi community may aggravate the INR fluctuations in warfarin-treated patients. During Ramadan, warfarin-treated patients are more prone to develop supra-therapeutic INR and therefore they deserve careful attention and closer INR monitoring.

Validation of EUROMACS-RHF (European Registry for Patients with Mechanical Circulatory Support Right-Sided Heart Failure) Score in Predicting Early Right Heart Failure Following Left Ventricular Assist Device Insertion in an Australian Single-Centre Cohort

Validation of EUROMACS-RHF (European Registry for Patients with Mechanical Circulatory Support Right-Sided Heart Failure) Score in Predicting Early Right Heart Failure Following Left Ventricular Assist Device Insertion in an Australian Single-Centre Cohort

P6047Comparison of different anticoagulation regimens in pregnant patients with mechanical prosthetic heart valves

P6047Comparison of different anticoagulation regimens in pregnant patients with mechanical prosthetic heart valves

EARLY POSTOPERATIVE PERIOD AFTER ORTHOTOPIC HEART TRANSPLANTATION IN RECIPIENTS OF 60 YEARS AND OLDER

Introduction. Increase in the number of older patients with terminal CHF results in increase in their proportion among potential recipients requiring mechanical circulatory support and/or heart transplantation (HT) [Abecassis M., Bridges N.D. et al., 2012].Aim.To analyze our own experience of HT in recipients of older 60 years.Materials and methods. The study included 63 patients (56 men (93.3% ) and 4 (6.7%) women) aged 60–74 years (63.0 ± 0.8) with body weight of 76.6 ± 1.4 kg, body surface area of 1.7 ± 0.02 m2, and body mass index of 23.4 ± 0.6. Indications for heart transplantation: dilated cardiomyopathy – 24 (38.1%), coronary heart disease – 34 (54.0%), hypertrophic cardiomyopathy – 2 (3.2%), irreversible cardiac graft dysfunction – 3 (4.7%). 46 (73.0%) patients had NYHA functional Class III and 17 (23.0%) patients – Class IV. Transpulmonary pressure gradient was 11.2 ± 2.7 mmHg, pulmonary vascular resistance – 3.5 ± 1.3 Wood units. According to UNOS algorithm 10 (15.9%) patients were listed as Status 1A of urgency of orthotopic cardiac transplantation (VA ECMO, n = 8, and implantable left ventricular assist device, n = 2), 21 (33.3%) patients as Status 1B, and 32 (50.8%) patients as Status 2. Recipients had the following comorbidities: arterial hypertension (n = 51; 81.0%), diabetes mellitus (n = 6; 9.5%), cerebrovascular disease (n = 13; 20.6%), history of stroke (n = 9; 14.3%), dialysisindependent renal dysfunction (n = 21; 33.3%). Before cardiac transplantation 9 (14.2%) recipients underwent various thoracic surgeries, 2 (3.2%) recipients – brain surgery. Heart donors (49 (77.8%) men and 14 (22.2%) women) were aged 18–59 (34.3 ± 10.4) years.Results. ICU hospitalization lasted for 4–15 (8.2 ± 0.5) days. In 61.9% of cases (n = 39) early postoperative and hospital periods were uncomplicated. Early on-table postoperative activation («early» tracheal extubation) was performed in 32 (50.8%) patients in 48 ± 6 minutes after surgery completion. 2 (3.2%) recipients demonstrated early graft dysfunction and required VA ECMO. Complications other than graft dysfunction were in 24 (38.1%) recipients: renal dysfunction (n = 8; 12.7%), renal and hepatic dysfunction (n = 4; 6.3%), infections (bacterial pneumonia, n = 3, [4.8%]), dyscirculatory encephalopathy (n = 9; 14.3%). 12 (19.0%) patients required continuous renal replacement therapy, 10 of them (15.9%) demonstrated renal function recovery. In 2 (3.2%) cases long-term hemodialysis was used. Hospital lethality (n = 6; 9.5%) was due to multiple organ failure syndrome and sepsis.Conclusion.Our own experience demonstrates satisfactory short-term and long-term survival after heart transplantation in recipients of 60 years and older.

Midterm outcomes of mechanical versus bioprosthetic valve replacement in middle-aged patients: An Indian scenario

Objective: The goal of this study is to evaluate and compare the midterm outcomes of bioprosthetic heart valve replacement in terms of survival, valve-related events, quality of life, and economic aspects of treatment in population age 45 years and above in females and 48 years in males and their comparison with mechanical valve recipients. Materials and Methods: The patient population under age group of 45–60 years is randomly divided into two groups: One receiving bioprosthetic valves and other receiving mechanical valves. Patients were followed up and data are analyzed. Results: The overall 10-year survival was similar in patients receiving bioprosthetic heart valve and mechanical heart valves. The incidence of major bleeding episodes was very high with mechanical valves (mitral valve replacement [MVR] = 14.3% and aortic valve replacement [AVR] =7.2%) as compared to 0.6% and 0.8% with bioprosthetic MVR and AVR, respectively. About 1.02% of patients with tissue valves have episodes of thromboembolism versus 8.3% patients with mechanical valves. Acute valve thrombosis rates were high in mechanical valve (3.1% vs. 0.0%). Incidences of endocarditis were also more with mechanical valve replacement group (2.3% vs. 0.3%). The quality of life was also better in patients with bioprosthetic valves. Conclusions: Bioprosthetic heart valves seem to be more beneficial in the Indian scenario as compared to mechanical valves because of low incidence of mortality and valve-related events and better quality of life.

Prophylactic anticoagulation for pregnant women with high risk of thrombosis

Pregnant women are usually in a hypercoagulable state; if it is complicated with high risk conditions of thrombosis, such as obesity, pregnancy-induced hypertension, mechanical heart valve replacement, systemic lupus erythematosus and antiphospholipid syndrome, prophylactic anticoagulation therapy with heparin/warfarin will be required. Due to pros and cons of heparin/warfarin, there is a controversy about how to choose anticoagulants. This article reviews the current status and progress of drug prophylaxis for thrombosis disease, and related issues particularly for administration of heparin and warfarin. Key words: Pregnant women; Thrombophilia; Protective agents

Peri-operative Antithrombotic Therapy in Hair Transplantation

1. Kuniyoshi Yagyu, MD, FISHRS (nhttkyo11{at}kioicho.jp) 1. Tokyo, Japan Patients under antithrombotic therapy sometimes visit our clinic for hair transplantation. Antithrombotic therapy is of critical importance to prevent serious cardiovascular events in patients with a mechanical heart

ESPAMACS: el nuevo Registro Español de Asistencia Mecánica Circulatoria

ESPAMACS is the new Spanish Registry for Mechanical Circulatory Support that has been created within the Working Group on Mechanical Circulatory Support and Heart Transplantation of the Spanish Society of Thoracic-Cardiovascular Surgery (GRUTAT-SECTCV), with the aim of registering all the short- and long-term support devices implanted in Spain. Technically, it is an on-line database that allows users to enter data in real time from any place with Internet access. It has been operational since October 2014, replacing the previous Microsoft Excel database that collected data between 2007 and 2012. In the present article, the need for a registry like this is justified as it is based on the current scenario of the treatment of end-stage heart failure, characterised by the progression of mechanical circulatory support and the limited availability of heart transplantation. The features and operating mode of ESPAMACS are also described: ownership, access mode, planning and development, funding, aims, ethical aspects, requirements for participation, patient selection, approved devices, design, registered variables, data acquisition system for statistical analysis and subsequent conducting of scientific studies, and quality control.

Left ventricular partitioning in systolic heart failure subjects: addressing a mechanistic void with current therapies.

ICD patients with narrow QRS, CRT non-responders, and functional MR patients all have one mechanistic failure mode that is left untreated - the scar left behind following an MI. ICDs, CRTs, and MitraClip implantation are all well-proven therapies, but the Parachute device may address the mechanistic void that remains after each of these therapies has been used and may further improve patients' outcomes. A pooled analysis of 134 subjects was conducted using the first three clinical trials which included subjects with symptomatic ischaemic HF with LV wall motion abnormalities secondary to MI, and an LV ejection fraction less than 40%. The two-year cumulative mortality rate was 12.9%, with 8.7% in the first year and an increment of 4.2% in the second, which is a 53% reduction as compared to the first year. There is a significant proportion of patients with ischaemic heart failure being excluded from cardiac rhythm management (CRT, etc.), leaving a large treatment gap until mechanical support devices (LVAD) or heart transplantation in progressive heart failure are indicated. Along with other heart failure devices, Parachute may be a useful treatment modality, addressing a mechanistic void in the treatment of this disease. Current data support improvements in haemodynamics, functional capacity, six-minute walk distance, quality of life and a promising decline in mortality two years after Parachute implantation.

Mekanik Protez Kalp Kapaklı Bir Hastada Spontan Prepatellar Bursa Hematomu

Mekanik Protez Kalp Kapaklı Bir Hastada Spontan Prepatellar Bursa Hematomu

Analysis of Flow Field in Mechanical Aortic Bileaflet Heart Valves Using Finite Volume Method

Under physiological conditions, the opening and closing of the leaflets of an implanted artificial heart valve (AHV) affects the blood components and therefore may cause various complications to the patient such as hemolysis or platelet activation. In this paper, a computational fluid model is presented. The regional distribution of flow shear stress in an AHV is analyzed using computational fluid dynamics and AHV performance is evaluated in terms of the variation of flow velocity and pressure when blood passes the leaflets in the aortic valve. The results suggest that for the design of a mechanical AHV, the maximum opening angle and internal orifice diameter should be increased to improve the fluid structure interaction and decrease the possibility of damage to blood components. Finally, the fluid stress distribution of the AHV leaflet structure was calculated and analyzed under pulsating flow conditions.

Spare and Found Parts by Sarah Maria Griffin

Reviewed by: Spare and Found Parts by Sarah Maria Griffin Kate Quealy-Gainer, Assistant Editor Griffin, Sarah Maria Spare and Found Parts. Greenwillow, 2016 [416p] Trade ed. ISBN 978-0-06-240888-4 $17.99 E-book ed. ISBN 978-0-06-240890-7 $9.99 Reviewed from galleys Ad Gr. 7-10 Tick tick tick. The sound of Nell Crane’s mechanical heart follows her around wherever she goes, making her feel an outsider even among others who have also lost body parts to the epidemic that swept through the city years ago. Her father is the great scientist who developed the biomechanical limbs that nearly every resident uses, and, in her search for a friend, Nell begins to wonder if it’s possible to go beyond his biomechanics and make a whole body out of spare parts. Such a body, however, would have to have a central control system, a system that would look [End Page 127] an awful lot like a computer and code, technology that has long been banished as the purported source of the illness. Although the premise of a dystopia with some Frankenstein flair is intriguing, the first half of the book moves at a snail’s pace; Nell is self-centered, self-pitying, and mean, but not in any appealing anti-hero kind of way, and she could win a medal in moping. Still, Griffin is pretty crafty as she builds her world, mostly using dialogue to establish the backstory of the plague and its current effects and offering subtle hints about the world’s past (for instance, readers will surely recognize Nell’s find of a slim silver box that plays music as an iPod). The intriguing setting offers some compensation for the flaws, and readers willing to slog through the book’s first half will be rewarded with a twist ending that brings all the disparate elements together in fine form. Copyright © 2016 The Board of Trustees of the University of Illinois

Development of Biofunctionalized Cellulose Acetate Nanoscaffolds for Heart Valve Tissue Engineering

Currently-used mechanical and biological heart valve prostheses have a satisfactory short-term performance, but may exhibit several major drawbacks on the long-term. Mechanical prostheses, based on carbon, metallic and polymeric components, require permanent anticoagulation treatment, and their usage often leads to adverse reactions, e.g. thromboembolic complications and endocarditis. In recent years, there is a need for a heart valve prosthesis that can grow, repair and remodel. The concept of tissue engineering offers good prospects into the development of such a device. An ideal scaffold should mimic the structural and purposeful profile of materials found in the natural extracellular matrix (ECM) architecture. The goal of this study was to develop cellulose acetate scaffolds (CA) for valve tissue regeneration. After their thorough physicochemical and biological characterization, a biofunctionalization process was made to increase the cell proliferation. Especially, the surface of scaffolds was amplified with functional molecules, such as RGD peptides (Arg-Gly-Asp) and YIGSRG laminins (Tyrosine-Isoleucine-Glycine-Serine-Arginine-Glycine) which immobilized through biotin-streptavidin bond, the strongest non-covalent bond in nature. Last step was to successfully coat an aortic metallic valve with CA biofunctionallized nanoscaffolds and cultivate cells in order to create an anatomical structure comparable to the native valve. Promising results have been obtained with CA-based nanoscaffolds. We found that cells grown successfully on the biofunctionalized valve surface thereby scaffolds that resemble the native tissues, elaborated with bioactive factors such as RGD peptides and laminins not only make the valve’s surface biocompatible but also they could promote endothyliazation of cardiac valves causing an anti-coagulant effect

Streptokinase versus recombinant tissue-type plasminogen activator for thrombolysis of mechanical prosthetic heart valve thrombosis

Aims and Objectives: This study was designed to compare streptokinase (STK) versus recombinant tissue-type plasminogen activator (rt-PA) for thrombolysis in patients with prosthetic heart valve thrombosis (PHVT). Background: Optimal management of PHVT remains controversial. Thrombolytic therapy is a reasonable alternative to surgery. Numerous thrombolytic protocols with STK, urokinase, and rt-PA have been used over the past 40 years. So far there is a lack of consensus on the ideal thrombolytic agent for PHVT. There are no major studies comparing efficacy of STK versus rt-PA. Methods and Results: Sixty patients who underwent thrombolysis for PHVT over 1 year were studied. Forty-eight patients were thrombolysed with STK, whereas 12 patients received rt-PA. Overall 68.33% (41/60) patients showed complete response (CR), whereas 85% (51/60) showed some improvement in hemodynamics, with no significant difference in efficacy according to age, sex, duration from surgery, New York Heart Association Class III–IV, presence of atrial fibrillation, type of valve, or history of stroke. Overall 10% patients developed major complications with mortality of 5%. CR to thrombolytic therapy was numerically better with STK (72.9% vs. 50%; P = 0.12) and mortality was significantly higher in rt-PA (16.6% vs. 2%, P = 0.038). Mean duration of successful thrombolysis was significantly longer with STK as compared to rt-PA (22.96 ± 19.2 vs. 3 h). Conclusion: STK use as compared to rt-PA was associated with numerically more successful thrombolysis and significant lower mortality, hence may be optimal for elective thrombolysis.

Obstetric history after mechanical cardiac valve replacement

In patients who have undergone mechanical prosthetic heart valve replacement, pregnancy is associated with the risks of warfarin embryopathy. A significant proportion of our patient undergoing mechanical mitral cardiac valve replacement were females of child bearing age.