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ABSTRACT: The Levitronix CentriMag (Levitronix LLC, Waltham, Mass) ventricular assist system is designed for temporary left, right, or biventricular support. Advantages include ease of use, excellent reliability, and low thrombosis risk,. which may allow wider application of short-term support and improved outcomes in patients with cardiogenic shock. This multi-institutional study evaluated safety, effectiveness, and outcomes of the CentriMag in patients with cardiogenic shock.
Thirty-eight patients were supported at 7 centers. Patients included 12 after cardiotomy, 14 after myocardial infarction, and 12 with right ventricular failure after implantable left ventricular assist device placement. Devices were implanted in left (n = 8), right (n = 12), or biventricular (n = 18) configuration. Support was continued until recovery, transplantation, or implantation of long-term ventricular assist device.
Mean support duration for the entire cohort (n = 38) was 13 days (1-60 days), with 47% of patients (18/38) surviving 30 days after device removal. Mean CentriMag biventricular support (n = 18) duration was 15 days (1-60 days), with 44% (8/18) surviving at 30 days. Mean CentriMag right ventricular support with a commercially available left ventricular assist device (n = 12) duration was 14 days (1-29 days), with 58% (7/12) surviving at 30 days. Complications included bleeding (21%), infection (5%), respiratory failure (3%), hemolysis (5%), and neurologic dysfunction (11%). There were no CentriMag or pump failures.
In this preliminary study, the CentriMag provided short-term support for patients with cardiogenic shock with a low incidence of device-related complications and no device failures.
The Journal of thoracic and cardiovascular surgery 04/2011; 141(4):932-9. · 3.41 Impact Factor
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ABSTRACT: Anomalous origin of the right coronary artery from the pulmonary artery is a rare condition. Two cases are presented in this paper. One case was treated by ligation and coronary artery bypass. The other was treated by direct reimplantation of the anomalous coronary artery into the aorta.
Case Reports in Medicine 01/2011; 2011:642126.
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ABSTRACT: We present a case in which a patient with a previous sternotomy and left ventricular assist device (LVAD) implantation developed cardiac arrest during resternotomy for LVAD exchange. The surgeon refused chest compressions for fear of potential damage to the inflow cannula directly beneath the sternum. The perioperative team had no alternatives to external cardiac massage other than rapid deployment of extra-corporeal membrane oxygenation for mechanical support, so the anesthesiologist advised the nursing personnel to perform abdominal only cardiopulmonary resuscitation while the surgeon performed a femoral bypass to cannulate the groin for extra-corporeal membrane oxygenation support.
Journal of Cardiothoracic Surgery 01/2011; 6:91. · 1.19 Impact Factor
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Journal of the American College of Cardiology 06/2010; 56(1):e1. · 14.16 Impact Factor
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ABSTRACT: We hypothesize that implantation of left ventricular assist device through off-pump technique is feasible and has a comparable result to implantation on cardiopulmonary bypass and could improve one-year survival.
This retrospective, observational, single-center study was conducted on 29 consecutive patients at our institution who underwent off-pump left ventricular assist device implantation by a single surgeon.
Twenty-seven procedures were performed successfully using the off-pump technique. The survival rate was 92% at 30 days, 76% at 90 days, and 67% at one year. We compared the one-year survival of different implantation periods, and divided our study into three time intervals (2004-2005, 2006, and 2007). There was a trend in reduction in number of deaths over one year that demonstrated a decrease in death rate from 50% to 17%, as well as improvement in our experience over time. However, this trend is not statistically significant (p = 0.08) due to limited sample size.
Based upon our findings, off-pump left ventricular assist device implantation is a feasible surgical technique, and combining this technique with improved device technology in the future may provide even greater improvement in patient outcomes.
Journal of Cardiothoracic Surgery 01/2010; 5:123. · 1.19 Impact Factor
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ABSTRACT: Implantation of ventricular assist devices for cardiac support is normally performed using cardiopulmonary bypass. Post-operative complications could be minimized by the placement of these devices without the use of cardiopulmonary bypass.
We hypothesize that left ventricular assist devices (LVADs), in selected patients, can be implanted safely off-pump.
In 25 patients, LVADs were implanted off-pump (mean age 50 years; 64% male, 36% female; average left ventricular ejection fraction 15%). Pre-operatively 68% of patients were on inotropes, 25% had an intra-aortic ballon pump, and 44% had a previous sternotomy. Blood utilization intra- and post-operatively was relatively minimal with 1 re-exploration for bleeding. There were 3 deaths.
We describe a technique for successful placement of a left ventricular assist device without the use of cardiopulmonary bypass.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 08/2008; 27(7):718-21. · 3.54 Impact Factor
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The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 08/2008; 27(7):815-6. · 3.54 Impact Factor
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ABSTRACT: The Thoratec Implantable Ventricular Assist Device (Thoratec Corporation, Pleasanton, Calif) can be used for univentricular or biventricular support in patients with a body surface area as low as 1.3 m(2). Results of the multicenter clinical trial are reviewed.
Between October 2001 and June 2004, a total of 39 patients at 12 institutions were supported with the Thoratec Implantable Ventricular Assist Device. Twenty-four patients (62%) received left ventricular assist devices and 15 (38%) received biventricular assist devices. Indications included bridge to transplantation (n = 30) and postcardiotomy failure (n = 9). The control group included 100 patients from the Food and Drug Administration approval submissions for the paracorporeal version of the ventricular assist device.
Twenty-eight male and 11 female patients, with mean age of 48 years (16-71 years) and body surface area of 1.9 m(2) (1.3-2.4 m2) were supported for 3938 patient-days (10.8 patient-years). Mean left ventricular assist device flow index on the first postoperative day was 2.5 +/- 0.5 L/(min x m2). Mean duration of support was 101 days (9-597 days). Eighteen patients were discharged after a mean duration of 96 days. There were no ventricular assist device failures. Complications included 13 cases of bleeding requiring reexploration (33.3%), 1 embolic and 2 hemorrhagic strokes (7.7%), 5 driveline infections (12.8%), and 2 pocket infections (5%). Support to successful outcomes was 70% for bridge to transplantation and 67% for postcardiotomy recovery, versus historical results for the paracorporeal ventricular assist device of 69% for bridge to transplantation and 48% for postcardiotomy recovery.
The Thoratec Implantable Ventricular Assist Device is a new implantable pulsatile ventricular assist device that allows hospital discharge for patients as a bridge to transplantation or for postcardiotomy failure. It is the first Food and Drug Administration-approved implantable ventricular assist device with biventricular capability.
The Journal of thoracic and cardiovascular surgery 07/2007; 133(6):1573-80. · 3.41 Impact Factor
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ABSTRACT: In this study we evaluate load-independent ventricular function during left ventricular assist device (LVAD) support based solely on telemetered measurements of left ventricular (LV) pressure, which has not been reported previously.
Adult sheep underwent placement of an axial-flow LVAD, a telemetered LV pressure manometer and instruments for pressure-volume analysis. In unsedated sheep, the simultaneous determination of both stroke work/end-diastolic volume (SW/EDP [PRSW]; slope: M(W)) and LV triple-product (TP = LVSP . dP/dt . HR) vs LV end-diastolic pressure (TP/EDP; slope: M(TP)) were performed before and then after beta(1)-blockade using the LVAD to acutely unload the ventricle.
LVAD support (4.5 +/- 0.31 liters/min) was maintained for 1 week. During LV unloading "runs," the LVAD flow (Q(V)) increased (up to 5.8 +/- 0.71 liters/min), although there were decreases in SW (3,061 +/- 747 to 1,556 +/- 410 mm Hg ml(-1)), LV TP (3,127 +/- 397 to 1,019 +/- 335 x 10(5)) and LV EDP (18.2 +/- 1.2 to 9.7 +/- 1.8 mm Hg). The TP/EDP and SW/EDV relationships established during the unloading runs were highly linear (R(2) up to 0.95) and their slopes were reduced by beta-adrenergic blockade (p < 0.001).
The TP/EDP relationship established during LVAD unloading of the LV was load-independent and sensitive to changes in cardiac inotropy, and correlated with PRSW.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 02/2007; 26(2):159-66. · 3.54 Impact Factor
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The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 03/2006; 25(2):256-7. · 3.54 Impact Factor
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Benjamin C Sun
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ABSTRACT: The current indications for long-term mechanical support as bridge to transplantation first require the patient to be a transplant candidate. Often times a patient presents with limited history and refractory cardiogenic shock, where a full transplant work-up for contraindications cannot be safely performed. The use of short-term mechanical support can be used to help filter out many patients who have easily identifiable contraindications to heart transplant. Nevertheless, patients need to be listed for a heart transplant before the implantation of some of these devices. This paradigm needs to be altered, because there are many instances where mechanical support can be used to support a patient for an intervention to "make" them a transplant candidate where they otherwise would not have been. Long-term mechanical support can overcome the cardiac contraindication to the surgical/interventional therapy to "cure" them of the process that would have prevented them from being a good cardiac transplant candidate in the first place. Noncardiac surgical procedures are well tolerated in these patients [11]. The FDA is currently evaluating the Vented Electric Heartmate system for use as destination therapy for patients who are not transplant candidates. Approval for this indication (with a device that is already approved for bridge to transplantation) will allow this paradigm shift. This system could be used in the group who may be good candidates, but not determined. If they were subsequently determined to not be a good surgical candidate, they would be chronically supported with the LVAD as destination therapy.
Cardiology Clinics 03/2003; 21(1):51-5. · 1.36 Impact Factor
