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  • 1
    Online Resource
    Online Resource
    Left ventricle assist device pulsatility index at the time of implantation is associated with follow-up pulmonary hemodynamics
    SAGE Publications ; 2020
    In:  The International Journal of Artificial Organs Vol. 43, No. 7 ( 2020-07), p. 452-460
    Details
    In: The International Journal of Artificial Organs, SAGE Publications, Vol. 43, No. 7 ( 2020-07), p. 452-460
    Abstract: HeartMate II left ventricular assist device controllers provide data including pulsatility index, reflecting the relationship between pump function and hemodynamics. We propose that a higher pulsatility index at hospital discharge following implant may be associated with less vascular congestion and improved clinical outcomes. A retrospective analysis of 40 patients (age 59.2 ± 10.3 years) supported with the HeartMate II devices was conducted. Data revealed moderate Pearson correlations between pulsatility index at discharge and right atrial pressure, pulmonary artery systolic pressure, pulmonary artery diastolic pressure, mean pulmonary arterial pressure, and pulmonary capillary wedge pressure, respectively, post-surgery (median of 377 days), demonstrating a stronger relationship when analyzed for the EPC controller (n = 28) only (r = −.57, p  〈  .01; r = −.38, p  〈  .05; r = −.59, p  〈  .01; r = −.47, p = .01 and r = −.53, p  〈  .01, respectively). The pulsatility index derived from the EPC controller was associated with the significant risk of re-hospitalization within 1 and 2 years after the implantation of left ventricular assist device; hazard ratio = 0.557 with 95% confidence interval (0.315–0.983), p = .04 and hazard ratio = .579 (0.341–0.984), p = .04. A higher pulsatility index at discharge was associated with greater volume unloading, lower pulmonary pressures, and lower risk of all-cause re-hospitalizations within 1 and 2 years post-surgery. As such, pump-derived data may provide additional value in predicting left ventricular assist device hemodynamics.
    Type of Medium: Online Resource
    ISSN: 0391-3988 , 1724-6040
    URL: Article
    DOI: 10.1177/0391398819899403
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 1474999-3
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  • 2
    Online Resource
    Online Resource
    Non-invasive assessment of arterial pulsatility in patients with continuous-flow left ventricular assist devices
    SAGE Publications ; 2020
    In:  The International Journal of Artificial Organs Vol. 43, No. 2 ( 2020-02), p. 99-108
    Details
    In: The International Journal of Artificial Organs, SAGE Publications, Vol. 43, No. 2 ( 2020-02), p. 99-108
    Abstract: Long-term use of continuous-flow left ventricular assist devices may have negative consequences for autonomic, cardiovascular and gastrointestinal function. It has thus been suggested that non-invasive monitoring of arterial pulsatility in patients with a left ventricular assist device is highly important for ensuring patient safety and longevity. We have developed a novel, semi-automated frequency-domain-based index of arterial pulsatility that is obtained during suprasystolic occlusions of the upper arm: the ‘cuff pulsatility index’. Purpose: The purpose of this study was to evaluate the relationship between the cuff pulsatility index and invasively determined arterial pulsatility in patients with a left ventricular assist device. Methods: Twenty-three patients with a left ventricular assist device with end-stage heart failure (six females: age = 65 ± 9 years; body mass index = 30.5 ± 3.7 kg m −2 ) were recruited for this study. Suprasystolic occlusions were performed on the upper arm of the patient’s dominant side, from which the cuff pressure waveform was obtained. Arterial blood pressure was obtained from the radial artery on the contralateral arm. Measurements were obtained in triplicate. The relationship between the cuff pressure and arterial blood pressure waveforms was assessed in the frequency-domain using coherence analysis. A mixed-effects approach was used to assess the relationship between cuff pulsatility index and invasively determined arterial pulsatility (i.e. pulse pressure). Results: The cuff pressure and arterial blood pressure waveforms demonstrated a high coherence up to the fifth harmonic of the cardiac frequency (heart rate). The cuff pulsatility index accurately tracked changes in arterial pulse pressure within a given patient across repeated measurements. Conclusions: The cuff pulsatility index shows promise as a non-invasive index for monitoring residual arterial pulsatility in patients with a left ventricular assist device across time.
    Type of Medium: Online Resource
    ISSN: 0391-3988 , 1724-6040
    URL: Article
    DOI: 10.1177/0391398819868236
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 1474999-3
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  • 3
    Online Resource
    Online Resource
    ECMO Cannulation Controversies and Complications
    SAGE Publications ; 2009
    In:  Seminars in Cardiothoracic and Vascular Anesthesia Vol. 13, No. 3 ( 2009-09), p. 176-182
    Details
    In: Seminars in Cardiothoracic and Vascular Anesthesia, SAGE Publications, Vol. 13, No. 3 ( 2009-09), p. 176-182
    Abstract: Advances in extracorporeal life support have expanded indications for use extending beyond patients undergoing cardiac surgery. The approach to cannulation in patients requiring extracorporeal membrane oxygenation should be individualized and based on the specific clinical scenario in which the need arises. Adherence to proper techniques of vessel visualization, exposure, and cannulation along with accurate placement of cannulae will optimize flows and minimize complications in this setting. Patients in need of mechanical circulatory support require input from a multidisciplinary team approach with systematic clinical evaluation to optimize outcome. If hemodynamics do not initially permit the successful separation from mechanical support, then a systematic search for potentially reversible patient and/ or pump related factors should be undertaken. The success of this therapy is predicated on patient selection, a multidisciplinary team approach in the intensive care unit, adherence to precise technical principles, and repeated patient evaluation.
    Type of Medium: Online Resource
    ISSN: 1089-2532 , 1940-5596
    URL: Article
    DOI: 10.1177/1089253209347943
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2009
    detail.hit.zdb_id: 2233047-1
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  • 4
    Online Resource
    Online Resource
    Reoperations After Repair of Partial and Complete Atrioventricular Septal Defect
    SAGE Publications ; 2010
    In:  World Journal for Pediatric and Congenital Heart Surgery Vol. 1, No. 1 ( 2010-04), p. 97-104
    Details
    In: World Journal for Pediatric and Congenital Heart Surgery, SAGE Publications, Vol. 1, No. 1 ( 2010-04), p. 97-104
    Abstract: The most common cause of reoperation following repair of atrioventricular septal defect (AVSD) is left atrioventricular valve regurgitation. However, reoperation for subaortic obstruction is required in some, especially after initial repair of partial AVSD. Etiology of reoperation and late outcome were evaluated. Between 1962 and 2007, 146 patients (59 male) underwent reoperation at the authors' institution after prior repair of partial (n = 96) and complete (n = 50) AVSD. Median age at reoperation after repair of partial AVSD was 26 years (range, 10 months to 71 years) and 4.5 years (range, 53 days to 38 years) after repair of complete AVSD. The 3 most common indications for reoperation included left atrioventricular (AV) valve regurgitation in 105 patients, subaortic stenosis in 29, and right AV valve regurgitation in 21. The most common procedures performed included left AV valve repair in 59 (40%) patients, left AV valve replacement in 56 (38%), subaortic fibrous resection/myectomy in 24 (16%), and right AV valve surgery in 19 (13%). Freedom from subsequent reoperation at 10 years was 48% after initial repair of complete AVSD and 84% after initial repair of partial AVSD. During late follow-up, 10-year actuarial survival was 91% and 77% after initial repair of complete and partial AVSD, respectively. The most common indication for reoperation after initial repair of partial or complete AVSD is left AV valve pathology; left ventricular outflow tract obstruction was more common in partial AVSD. Although freedom from subsequent reoperations is higher after initial repair of partial AVSD, these patients have reduced long-term survival when compared with complete AVSD.
    Type of Medium: Online Resource
    ISSN: 2150-1351 , 2150-136X
    URL: Article
    DOI: 10.1177/2150135110362453
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2010
    detail.hit.zdb_id: 2550261-X
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