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Arthur R Garan,
Melana Yuzefpolskaya,
Paolo C Colombo,
John P Morrow,
Rosie Te-Frey,
Drew Dano,
Hiroo Takayama,
Yoshifumi Naka,
Hasan Garan,
Ulrich P Jorde, Nir Uriel
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ABSTRACT: OBJECTIVES: The purpose of this study was to evaluate the prevalence and significance of ventricular arrhythmias (VA) and the role of ICDs in patients supported by continuous-flow left-ventricular assist device (CF-LVADs). BACKGROUND: VAs are common in patients supported by CF-LVADs but prospective data to support the routine use of ICDs in these patients are lacking. METHODS: All patients supported by long-term CF-LVAD receiving care at our institution were enrolled. ICDs were interrogated at baseline and throughout prospective follow-up. VA was defined as VT/VF lasting > 30 seconds or effectively terminated by appropriate ICD tachytherapy. The primary outcome was the occurrence of VAs > 30 days following CF-LVAD implantation. RESULTS: Ninety-four patients were enrolled; seventy-seven had an ICD and 17 did not. Five patients with an ICD had it de-activated or a depleted battery not replaced during the study. Twenty-two patients experienced a VA > 30 days post LVAD implantation. Pre-operative VA was the major predictor of post-operative arrhythmia. Absence of pre-operative VA conferred a low risk of post-operative VA (4.0% vs. 45.5%; p< 0.001). No patients discharged from the hospital without an ICD following CF-LVAD implantation died during 276.2 months of follow-up (mean time without ICD 12.7±12.3 months). CONCLUSIONS: Patients with pre-operative VAs are at risk of recurrent VAs while on CF-LVAD support and should have active ICD therapy to minimize sustained VAs. Patients without pre-operative VAs are at low risk and may not need active ICD therapy.
Journal of the American College of Cardiology 05/2013; · 14.16 Impact Factor
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P Christian Schulze,
Jeffrey Jiang,
Jonathan Yang,
Faisal H Cheema,
Kenneth Schaeffle,
Tomoko S Kato,
Maryjane Farr,
Susan Restaino,
Mario Deng,
Mathew Maurer, [......],
Paolo C Colombo,
Ulrich Jorde, Nir Uriel,
Jennifer Haythe,
Rachel Bijou,
Ron Drusin,
Sun Hi Lee,
Hiroo Takayama,
Yoshifumi Naka,
Donna M Mancini
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ABSTRACT: BACKGROUND: -Alternate waiting list strategies expand listing criteria for patients awaiting heart transplantation (HTx). We retrospectively analyzed clinical events and outcome of patients listed as "high risk" recipients for HTx. METHODS AND RESULTS: -We analyzed 822 adult patients who underwent HTx of whom 111 patients met high risk criteria. Clinical data were collected from medical records and outcome factors calculated for 61 characteristics. Significant factors were summarized in a prognostic score. Age>65 years (67%) and amyloidosis (19%) were the most common reason for alternate listing. High risk recipients were older (63.2±10.2 versus 51.4±11.8 yrs; p<0.001), had more renal dysfunction, prior cancer and smoking. Survival analysis revealed lower post-HTx survival in high risk recipients (82.2 versus 87.4 % at 1-yr; 59.8 versus 76.3 % at 5-yrs post-HTx; p=0.0005). Prior CVA, Albumin<3.5 mg/dL, Re-HTx, Renal dysfunction (GFR<40 ml/min) and >2 prior Sternotomies were associated with poor survival following HTx. A prognostic risk score (CARRS) derived from these factors stratified survival post-HTx in high risk (3+ points) versus low risk (0-2 points) patients (87.9 versus 52.9 % at 1-yr; 65.9 versus 28.4 % at 5-yrs post-HTx; p<0.001). Low risk alternate patients had survival comparable to regular patients (87.9 versus 87.0 % at 1-yr and 65.9 versus 74.5 % at 5-yrs post-HTx; p=0.46). CONCLUSIONS: -High risk patients had reduced survival compared to regular patients post-HTx. Among patients previously accepted for alternate donor listing, application of the CARRS score identifies patients with unacceptably high mortality following HTx and those with a survival similar to regularly listed patients.
Circulation Heart Failure 03/2013; · 6.29 Impact Factor
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ABSTRACT: Left Ventricular Assist Devices (LVAD) are increasingly used as a bridge to transplant (BTT) for patients with advanced congestive heart failure (CHF) and are assigned United Network for Organ Sharing (UNOS) high priority status (1B or 1A).
The purpose of our study was asses the effect of organ allocation in the era of continuous flow pumps. A retrospective chart review was performed of all patients transplanted between 1/2001-1/2011 at Columbia University Medical Center.
Seven hundred twenty six adult heart transplantations were performed. Two hundred seventy four BTT patients were implanted with LVAD; of which 227 patients were transplanted. Sixty three patients were transplanted as UNOS-1B, while 164 were transplanted as UNOS-1A (72%). Of these 164 patients, 65 were transplanted during their 30-day 1A period (43%) and 96 after upgrading to UNOS-1A for device complication (56%). For 452 non-device patients 139 (31%) were transplanted as UNOS-1A, 233 as UNOS-1B (52%), and 80 as UNOS-2 (17%). The percentage of patients bridged with LVAD increased from 19% in 2001 to 64% in 2010 while the number transplanted during their 30 day 1A grace period declined from 57% in 2005 to 16% in 2011; i.e. 84% of BTT patients in 2011 needed more than 30 days 1A time to be transplanted. Most LVAD patients are now transplanted while suffering device complication. There was no difference in post transplant survival between LVAD patients transplanted as UNOS 1B, 1A grace period or for a device complication
As wait time for cardiac transplantation increased the percentage of patients being bridged to transplant with an LVAD has increased with the majority of them transplanted in the setting of device complication.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 02/2013; 32(2):188-95. · 3.54 Impact Factor
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Journal of the American College of Cardiology 01/2013; 61(4):483-4. · 14.16 Impact Factor
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Circulation 01/2013; 127(4):e431. · 14.74 Impact Factor
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Melana Yuzefpolskaya, Nir Uriel,
Daniel S Chow,
Susan W Restaino,
Donna M Mancini,
Margaret Flannery,
Rosie Te-Frey,
Joanne Chichetti,
Takeyoshi Ota,
Hyonah Kim,
Drew D Dano,
Gregory D Pearson,
Hiroo Takayama,
Yoshifumi Naka,
Ulrich P Jorde
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ABSTRACT: BACKGROUND: On April 4, 2012, the U.S. Food and Drug Administration issued a Class 1R recall of the HeartMate II (Thoratec Corporation, Pleasanton, CA) left ventricular assist device (LVAD) due to spontaneous detachment of the bend relief from its intended position in patients implanted with the most recent version of the HM II. This study examined the incidence and timing of outflow graft bend relief disconnection in patients implanted with the HM II LVAD. METHODS: All patients supported with the modified version of the HM II LVAD were asked to report for dedicated abdominal X-ray imaging to assess the position of the bend relief. Also performed was a retrospective review of X-ray images of all patients who had previously been supported with this version but had since received a transplant, undergone LVAD explant, or died. RESULTS: Between March 9, 2011, and April 9, 2012, 59 patients underwent primary implant with the modified version HM II. Follow up X-ray images were available for 56 patients (95%). The bend relief was found fully disconnected in 6 of 56 (11%) and partially disconnected in 13 (23%). Two of 6 patients (33%) with full bend relief disconnection and 1 of 13 of the initially partially disconnected patients (7.7%) required urgent surgical intervention due to symptoms of hemolysis and/or heart failure. CONCLUSION: Bend relief disconnection is common and may be observed immediately after implant but may also develop over time. Full bend relief disconnect may present with hemolysis and/or heart failure symptoms and often requires surgical revision. Surveillance abdominal X-ray imaging should be performed routinely on all patients who were implanted with the modified version HM II.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 01/2013; · 3.54 Impact Factor
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ABSTRACT: Mortality for refractory cardiogenic shock (RCS) remains high. However, with improving mechanical circulatory support device (MCSD) technology, the treatment options for RCS patients are expanding. We report on a recent 5-year single-center experience with MCSD for treatment of RCS.
This study was a retrospective review of adult patients who required an MCSD due to RCS in the past 5 years. We excluded those patients with post-cardiotomy shock and post-transplant cardiac graft dysfunction. In the setting of RCS, a short-term ventricular assist device (VAD) was inserted as a bridge-to-decision device. Veno-arterial extracorporeal membrane oxygenation (VA ECMO) was chosen in cases of unknown neurologic status, complete hemodynamic collapse or severe coagulopathy.
From January 2007 through January 2012, 90 patients received an MCSD for RCS, 21 (23%) of whom had active cardiopulmonary resuscitation (CPR). The etiology of RCS included acute myocardial infarction in 49% and acute decompensated heart failure in 27%. Mean age was 53±14 years, 71% were male, and 60% had an intra-aortic balloon pump. The initial approach utilized was short-term VAD in 49% and VA ECMO in 51%. Median length of support was 8 days (IQR 4 to 18 days). Exchange to implantable VAD was performed in 26% of patients. Other destinations included myocardial recovery in 18% and heart transplantation in 11%. Survival to hospital discharge was 49%. Multivariate analysis showed ongoing CPR to be an independent risk factor for mortality (OR = 5.79, 95% CI 1.285 to 26.08, p = 0.022).
In the current era, roughly half of the patients who need an MCSD for RCS survive, and roughly half of these survivors require an implantable VAD. Ongoing CPR is predictive of in-hospital mortality.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 01/2013; 32(1):106-11. · 3.54 Impact Factor
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Nir Uriel,
Kerry A Morrison,
Arthur R Garan,
Tomoko S Kato,
Melana Yuzefpolskaya,
Farhana Latif,
Susan W Restaino,
Donna M Mancini,
Margaret Flannery,
Hiroo Takayama,
Ranjit John,
Paolo C Colombo,
Yoshifumi Naka,
Ulrich P Jorde
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ABSTRACT: This study sought to develop a novel approach to optimizing continuous-flow left ventricular assist device (CF-LVAD) function and diagnosing device malfunctions.
In CF-LVAD patients, the dynamic interaction of device speed, left and right ventricular decompression, and valve function can be assessed during an echocardiography-monitored speed ramp test.
We devised a unique ramp test protocol to be routinely used at the time of discharge for speed optimization and/or if device malfunction was suspected. The patient's left ventricular end-diastolic dimension, frequency of aortic valve opening, valvular insufficiency, blood pressure, and CF-LVAD parameters were recorded in increments of 400 rpm from 8,000 rpm to 12,000 rpm. The results of the speed designations were plotted, and linear function slopes for left ventricular end-diastolic dimension, pulsatility index, and power were calculated.
Fifty-two ramp tests for 39 patients were prospectively collected and analyzed. Twenty-eight ramp tests were performed for speed optimization, and speed was changed in 17 (61%) with a mean absolute value adjustment of 424 ± 211 rpm. Seventeen patients had ramp tests performed for suspected device thrombosis, and 10 tests were suspicious for device thrombosis; these patients were then treated with intensified anticoagulation and/or device exchange/emergent transplantation. Device thrombosis was confirmed in 8 of 10 cases at the time of emergent device exchange or transplantation. All patients with device thrombosis, but none of the remaining patients had a left ventricular end-diastolic dimension slope >-0.16.
Ramp tests facilitate optimal speed changes and device malfunction detection and may be used to monitor the effects of therapeutic interventions and need for surgical intervention in CF-LVAD patients.
Journal of the American College of Cardiology 09/2012; 60(18):1764-75. · 14.16 Impact Factor
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The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 08/2012; 31(11):1238-9. · 3.54 Impact Factor
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ABSTRACT: Background- Chronotropic incompetence is defined as the inability to reach 80% of heart rate (HR) reserve or 80% of the maximally predicted HR during exercise. The presence of chronotropic incompetence is associated with reduced peak oxygen consumption, and rate-responsive pacing therapy is under investigation to improve exercise capacity in heart failure (HF). However, uncertainty exists about whether chronotropic incompetence and reduced exercise tolerance in HF are attributable to β-blockade. Methods and Results- Subjects with HF and receiving long-term β-blocker therapy underwent cardiopulmonary exercise tolerance testing under 2 conditions in random sequence: (1) after a 27-hour washout period (Off-BB) and (2) 3 hours after β-blocker ingestion (On-BB). Norepinephrine levels were drawn at rest and at peak exercise. β1-response to norepinephrine was assessed using the chronotropic responsiveness index: ΔHR/Δlog norepinephrine. Nineteen patients with systolic HF (left ventricular ejection fraction, 22.8±7.7%) were enrolled. Mean age was 49.4±12.3 years. Average carvedilol equivalent dose was 29.1±17.0 mg daily. Peak HR off/on β-blockers was 62.7±18.7% and 51.4±18.2% HR reserve (P<0.01) and 79.1±11.0% and 70.3±12.3% maximally predicted HR (P<0.01). For the Off-BB and On-BB conditions, the respiratory exchange ratios were 1.05±0.06 and 1.05±0.10 (P=0.77), respectively, confirming maximal and near identical effort in both conditions. The peak oxygen consumption was 16.6±3.34 and 15.9±3.31 mL/kg/min (P=0.03), and the chronotropic responsiveness index was 19.3±7.2 and 16.2±7.1 (P=0.18). Conclusions- Acute β-blocker cessation does not normalize the chronotropic response to exercise in patients with advanced HF and chronotropic incompetence.
Circulation Heart Failure 08/2012; 5(5):560-5. · 6.29 Impact Factor
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ABSTRACT: The CentriMag ventricular assist device (VAD) has gained popularity in the last several years as rescue support for patients with decompensated heart failure. We have used the CentriMag VAD as a bridge to decision device. We describe our experience with device placement, use and outcomes.
This is a retrospective study of all patients who underwent CentriMag placement at our institution from January 2007 to August 2009. Sixty-three patients had placement of a CentriMag device, with 43% (n = 27) of these being placed due to failure of medical management. These cases were the focus of our study.
Primary diagnoses were ischemic cardiomyopathy (n = 17), dilated cardiomyopathy (n = 7) or other (n = 3). Mean age was 47.1 (range 7 to 72) years. Prior to implant, 85% of patients were on intra-aortic balloon pump (IABP) support, 70% were on vasopressors, and 44% were on more than one inotrope. INTERMACS score was 1 in 67% of patients and 2 in 33% of patients. Six patients were bridged to a long-term device, 8 to transplantation and 10 to recovery. Eighty-nine percent (24 of 27) of patients survived to explant and 74% (20 of 27) survived to hospital discharge, with a 1-year survival of 68%. Thromboembolic complications occurred in 10 patients, including 6 strokes. Compared with patients who survived to discharge, those who died had a significantly higher body mass index (30.8 vs 24.1 kg/m(2), p = 0.003). Survivors to discharge demonstrated significant improvements in hepatic and renal function over the course of device support while non-survivors did not.
The CentriMag demonstrates promising results when used in patients with acute heart failure refractory to medical management.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 06/2012; 31(6):611-7. · 3.54 Impact Factor
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ABSTRACT: Cardiogenic shock remains a deadly complication of acute myocardial infarction (MI). Early revascularization, inotropic support, and intraaortic balloon counterpulsation are the mainstays of treatment, but these are not always sufficient. New mechanical approaches, both percutaneous and surgical, are available in this high-risk population. We present a case of a young woman with a massive anterior wall MI and subsequent cardiogenic shock who was treated with advanced mechanical circulatory support. This case serves as an illustration of the stepwise escalation of mechanical support that can be applied in a patient with an acute MI complicated by refractory cardiogenic shock. We also review the literature with regard to the use of percutaneous left ventricular assist devices in the setting of cardiogenic shock.
Heart & lung: the journal of critical care 05/2012; 41(5):500-4. · 1.04 Impact Factor
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Lindsay K Murray,
Jose González-Costello,
Samual N Jonas,
Daniel B Sims,
Kerry A Morrison,
Paolo C Colombo,
Donna M Mancini,
Susan W Restaino,
Evan Joye,
Evelyn Horn,
Hiroo Takayama,
Charles C Marboe,
Yoshifumi Naka,
Ulrich P Jorde, Nir Uriel
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ABSTRACT: Giant cell myocarditis (GCM) carries a poor prognosis and many patients require end-stage therapies. This study sought to determine the outcome of patients bridged with ventricular assist devices (VAD) to orthotopic heart transplantation (OHT).
A retrospective data collection of all patients with GCM was performed. Diagnosis was determined by endomyocardial or explanted heart biopsy. Eight patients were found, but two of those patients went directly to OHT and were excluded. The remaining six patients received VADs, and these patients, aged 44 ± 18 years, were included. Five of the six patients were bridged with biventricular support and one patient was supported by left ventricular assist device (LVAD) alone. Two patients died on device support. Four patients were bridged to OHT 77 ± 42 days after device implantation. All four patients bridged with a VAD are alive, with a mean follow-up of 5.7 ± 4.1 years. Two patients were found to have recurrent GCM in the transplanted heart and were treated successfully with immunosuppression. Three patients had high grade (2R) rejection at 66 ± 52 days post-OHT. Cardiac function was preserved in all patients, and only one patient had cardiac allograft vasculopathy.
Patients with end-stage GCM can be successfully bridged with VADs to OHT with very good post-OHT survival. The proper immunosuppressive regimen for this group needs further investigation given the frequency of rejection and GCM recurrence.
European Journal of Heart Failure 03/2012; 14(3):312-8. · 4.90 Impact Factor
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José González-Costello,
Jonathan Yang,
Daniel B Sims,
Alexander P Kossar,
Lindsay K Murray,
Paolo C Colombo,
Hiroo Takayama,
Donna Mancini,
Yoshifumi Naka,
Ulrich P Jorde, Nir Uriel
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ABSTRACT: Patients in cardiogenic shock require immediate circulatory support. Outcomes of patients who underwent short-term ventricular assist device (STVAD) implantation in a community hospital (CH) as a bridge to a long-term VAD (LTVAD) were compared with those who received both implants at the same tertiary hospital (TH).
Data were retrospectively reviewed for patients with a STVAD who were bridged to a LTVAD in a TH from 1997 to 2010. We studied outcomes and survival censored for cardiac transplantation.
Thirty-seven patients (73% male) were identified. Mean age was 52 ± 16 years, 30% were diabetic, and 65% had intra-aortic balloon pump support. Reasons for STVAD implantation were an acute myocardial infarction, 38%; post-cardiotomy, 38%, decompensated chronic heart failure, 19%; and others, 5%. A STVAD was implanted in a CH in 20 patients (54%), and they had fewer cardiovascular risk factors than those whose STVAD was implanted at the TH. All patients at the CH were at Interagency Registry for Mechanically Assisted Circulatory Support 1 compared with 71% at the TH (p = 0.014). Patients from the CH tended to die sooner after LTVAD implant, although long-term survival was similar. At the 1-year follow-up, 65% from the CH were alive or had received a transplant vs 60% from the TH.
Patients with cardiogenic shock in whom a STVAD was implanted in a CH and then were bridged to a LTVAD in a TH had similar long-term survival as those bridged to LTVAD at the TH.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 02/2012; 31(6):618-24. · 3.54 Impact Factor
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Tomoko S Kato,
P Christian Schulze,
Jonathan Yang,
Ernest Chan,
Khurram Shahzad,
Hiroo Takayama, Nir Uriel,
Ulrich Jorde,
Maryjane Farr,
Yoshifumi Naka,
Donna Mancini
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ABSTRACT: Neurologic complications (NCs) are the major adverse events after left ventricular assist device (LVAD) surgery. Pre-operative and post-operative factors associated with NCs in patients with LVADs were investigated.
We reviewed 307 consecutive patients undergoing LVAD surgery (167 HeartMate I and 140 HeartMate II devices) at Columbia University Medical Center between November 2000 and December 2010. Clinical characteristics and hemodynamic and laboratory indexes were analyzed. NC was defined according to the Interagency Registry for Mechanically Assisted Circulatory Support definition of neurologic dysfunction, including transient ischemic attack (TIA) and ischemic or hemorrhagic cerebrovascular accident (CVA).
NCs developed in 43 patients (14.0%) at 91.8 ± 116.3 days post-operatively. The frequency of NC development was similar in HeartMate I and II patients. Patients with NC showed a higher frequency of pre-LVAD CVA history (27.9% vs 15.5%, p = 0.046), lower pre-operative sodium (129.0 ± 7.0 vs 132.1 ± 8.1 mg/dl, p = 0.018) and albumin concentrations (3.5 ± 0.7 vs 3.7 ± 0.6 mg/dl, p = 0.049), lower post-operative hematocrit (34.9% ± 5.1% vs 37.8% ± 6.1%, p = 0.0034), sodium (131.6 ± 7.7 vs 134.4 ± 6.4 mg/dl, p = 0.010) and albumin concentrations (3.7 ± 0.5 vs 3.9 ± 0.5 mg/dl, p = 0.0016), and higher frequency of post-operative infection (39.5% vs 19.3%, p = 0.003) than those without NC. Multiple regression analysis revealed that CVA history (odds ratio, 2.37, 95% confidence interval, 1.24-5.29; p = 0.011) and post-operative infection (odds ratio, 2.99, 95% confidence interval, 1.16-10.49; p = 0.011) were highly associated with NC development. The combination of CVA history, pre-operative and post-operative sodium and albumin, and post-operative hematocrit and infection could discriminate patients developing NCs with a probability of 76.6%.
Previous stroke, persistent malnutrition and inflammation, severity of heart failure, and post-LVAD infections are key factors associated with development of NCs after LVAD implantation.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 01/2012; 31(1):1-8. · 3.54 Impact Factor
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Berhane Worku,
Yoshifumi Naka,
Sang-Woo Pak,
Faisal H Cheema,
Osama T Siddiqui,
Jitendra Jain, Nir Uriel,
Reena Bhatt,
Paolo Colombo,
Ulrich Jorde,
Hiroo Takayama
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ABSTRACT: Risk assessment prior to long-term ventricular assist device (VAD) placement has been shown to be crucial for successful outcomes and efficient resource utilization. Short-term VADs are often used as salvage therapy in acute heart failure when the clinical scenario precludes such thorough preoperative assessment. Our goal was to devise a risk stratification system that may be used shortly after stabilization of hemodynamics with a short-term VAD to predict the likelihood of survival.
A retrospective study was performed of all patients undergoing Abiomed (Abiomed Cardiovascular Inc., Danvers, MA) or CentriMag (Levitronix LLC, Waltham, MA) placement at our institution or transferred to our institution with the device in place. From January 2001 until August 2009, 93 patients were identified. Preoperative and early postoperative variables were analyzed for their correlation with in-hospital mortality.
Multivariable logistic regression analysis identified factors that were associated with death. A three-point scoring system, utilizing a diagnosis of postcardiotomy shock or graft failure, female sex, and postoperative day 3 total bilirubin greater than 5.2 mg/dL was devised. A score of 2 or greater was associated with an 86% mortality rate, whereas a score of 0 was associated with a 13% mortality rate.
A simple scoring system based on readily available data may predict mortality after short-term VAD placement. Such a scoring system may be of prognostic value for physicians and patient families early in the support period and may help guide decisions.
The Annals of thoracic surgery 11/2011; 92(5):1608-12; discussion 1612-3. · 3.74 Impact Factor
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The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 09/2011; 30(9):1065-7. · 3.54 Impact Factor
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Circulation 08/2011; 124(7):e197-8. · 14.74 Impact Factor
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ABSTRACT: Although inflammation is a physiologic response designed to protect us from infection, when unchecked and ongoing it may cause substantial harm. Both chronic heart failure (CHF) and chronic kidney disease (CKD) are known to cause elaboration of several pro-inflammatory mediators that can be detected at high concentrations in the tissues and blood stream. The biologic sources driving this chronic inflammatory state in CHF and CKD are not fully established. Traditional sources of inflammation include the heart and the kidneys which produce a wide range of pro-inflammatory cytokines in response to neurohormones and sympathetic activation. However, growing evidence suggests that non-traditional biomechanical mechanisms such as venous and tissue congestion due to volume overload are also important as they stimulate endotoxin absorption from the bowel and peripheral synthesis and release of pro-inflammatory mediators. Both during the chronic phase and, more rapidly, during acute exacerbations of CHF and CKD, inflammation and congestion appear to amplify each other resulting in a downward spiral of worsening cardiac, vascular, and renal functions that may negatively impact patients' outcome. Anti-inflammatory treatment strategies aimed at attenuating end organ damage and improving clinical prognosis in the cardiorenal syndrome have been disappointing to date. A new therapeutic paradigm may be needed, which involves different anti-inflammatory strategies for individual etiologies and stages of CHF and CKD. It may also include specific (short-term) anti-inflammatory treatments that counteract inflammation during the unsettled phases of clinical decompensation. Finally, it will require greater focus on volume overload as an increasingly significant source of systemic inflammation in the cardiorenal syndrome.
Heart Failure Reviews 06/2011; 17(2):177-90. · 3.20 Impact Factor
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ABSTRACT: Left ventricular assist device (LVAD) therapy improves survival and quality of life by mechanically unloading the left ventricle and maintaining hemodynamics in patients with end-stage heart failure. LVADs can also be lifesaving by maintaining hemodynamics during ventricular arrhythmia. Continuous-flow LVADs have become the preferred LVAD technology. As presented here, a continuous-flow LVAD successfully provided hemodynamic support to a patient in sustained ventricular fibrillation for over 12 hours when the internal defibrillator was unable to terminate the arrhythmia. This case demonstrates that continuous-flow LVADs can be lifesaving in the setting of otherwise certain hemodynamic collapse from sustained ventricular fibrillation.
Pacing and Clinical Electrophysiology 06/2011; 35(5):e144-8. · 1.35 Impact Factor
