Jennifer Cowger

• MD, MS
• University of Michigan

Currently, the fully magnetically levitated left ventricular assist device (LVAD) HeartMate 3 (HM3) is the only commercially available device for advanced heart failure (HF) patients. However, the left ventricular (LV) functional and structural changes following mechanical unloading and circulatory support (MCS) with the HM3 have not been investiga...

Background Utilization of right ventricular mechanical circulatory support (RV‐MCS) devices has been limited by a lack of recognition of RV failure as well as a lack of availability and experience with RV‐MCS. Aims We report a single‐center experience with the use of percutaneous RV‐MCS and report predictors of adverse outcomes. Methods This was...

Background There has been a significant increase in the utilization of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in recent years. Cardiothoracic surgery teams have historically led VA-ECMO care teams, with little data available on alternative care models. Methods We performed a retrospective review of a cardiovascular medicine inc...

Right heart failure (RHF) management after left ventricular assist device (LVAD) implantation includes inotropes, right ventricular mechanical support, and heart transplantation. The purpose of this study is to compare different RHF treatment strategies in patients with a magnetically levitated centrifugal LVAD. A total of 6,632 Interagency Registr...

IMPORTANCE Left ventricular assist devices (LVADs) enhance quality and duration of life in advanced heart failure. The burden of nonsurgical bleeding events is a leading morbidity. Aspirin as an antiplatelet agent is mandated along with vitamin K antagonists (VKAs) with continuous-flow LVADs without conclusive evidence of efficacy and safety. OBJE...

Introduction: Approximately 1/3 of patients with acute decompensated heart failure (ADHF) are discharged with persistent congestion. Worsening renal function (WRF) occurs in approximately 50% of patients hospitalized for ADHF and the combination of WRF and persistent congestion are associated with higher risk of mortality and HF readmissions. Met...

Spontaneous coronary artery dissection (SCAD) is a common cause of myocardial infarction in young and middle-aged women. Patients with SCAD present rarely with hemodynamic collapse and cardiogenic shock, requiring immediate resuscitation and mechanical circulatory support. Percutaneous mechanical circulatory support may serve as a bridge to recover...

The medical management of patients supported with durable continuous flow left ventricular assist device (LVAD) support encompasses pharmacological therapies administered in the preoperative, intraoperative, postoperative, and chronic LVAD support stages. As patients live longer on LVAD support, the risks of LVAD-related complications and progressi...

Introduction: Existing models predicting right ventricular failure (RVF) after durable left ventricular assist device (LVAD) support are limited due to lack of multicenter validation, absence of intraoperative characteristics, and marginal predictive power. We sought to derive and validate a risk model to predict post-LVAD RVF. Methods: Advanced he...

Introduction: Although significant cardiac reverse remodeling is a prerequisite for a left ventricular (LV) assist device (LVAD) patient to be considered for device weaning, multiple factors including patient goals, physician comfort, and center experience, weigh in on this complex decision. Existing predictive models defining recovery as device re...

Introduction: Advanced data analytics are needed to reliably predict bleeding and thrombotic risk in ambulatory left ventricular assist device (LVAD) patients. Hypothesis: Machine learning techniques can be used to predict risk of gastrointestinal bleeding (GIB), stroke, or death in ambulatory LVAD patients. Methods: HeartMate 3 TM LVAD recipients...

Veno-arterial extracorporeal membrane oxygenation is used in patients requiring biventricular support; however, its use increases the afterload. In patients with severe aortic insufficiency or severe left ventricular disfunction, it will increase left-side filling pressures, hence the need for left ventricle unloading with an additional mechanical...

Background Atrial and ventricular arrhythmias are commonly encountered in patients with advanced heart failure, with amiodarone being the most commonly used antiarrhythmic drug in continuous‐flow left ventricular assist device (CF‐LVAD) recipients. The purpose of this study was to assess the impact of amiodarone use on long‐term all‐cause mortality...

Background Outcomes in patients with smaller body size following HeartMate 3 Left Ventricular Assist Device (HM3) implantation are not well characterized. We sought to evaluate outcomes in smaller vs. larger BSA patients in the MOMENTUM 3 pivotal trial and its Continued Access Protocol cohort. Methods The analysis cohort included 1015 HM3 patients...

Background : There is paucity of data regarding durable LVAD outcomes in patients with chronic kidney disease (CKD) stage 3-5 and CKD stage 5 on dialysis (ESRD: end stage renal disease). Methods : We conducted a retrospective study of Medicare beneficiaries with ESRD and 5% sample of CKD with LVAD (2006 to 2018) to determine one-year outcomes util...

Introduction : The Utah Right Ventricular Failure (RVF) Risk score is a 7-factor predictive model (African American, history of HTN, INTERMACS profile 1-2, Na <130mEq/L, BUN >35mg/dL, PA pulse pressure <36mmHg and RA/PCWP >0.5) that achieved a high discriminative performance (AUC 0.73) for predicting RVF in a three-center study of patients undergoi...

Background Cardiogenic shock (CS) is associated with significant morbidity and mortality. Differentiating the etiologic factors driving CS has epidemiological significance and aids in optimization of therapeutic strategies, prognostication and resource utilization. The aim herein is to investigate the epidemiology and clinical outcomes of cardiogen...

The HeartWare HVAD System (Medtronic) is a durable implantable left ventricular assist device that has been implanted in approximately 20,000 patients worldwide for bridge to transplant and destination therapy indications. In December 2020, Medtronic issued an Urgent Medical Device Communication informing clinicians of a critical device malfunction...

The HeartWare HVAD System (Medtronic) is a durable implantable left ventricular assist device that has been implanted in approximately 20,000 patients worldwide for bridge to transplant and destination therapy indications. In December 2020, Medtronic issued an Urgent Medical Device Communication informing clinicians of a critical device malfunction...

The HeartWare HVAD System (Medtronic) is a durable implantable left ventricular assist device that has been implanted in approximately 20,000 patients worldwide for bridge to transplant and destination therapy indications. In December 2020, Medtronic issued an Urgent Medical Device Communication informing clinicians of a critical device malfunction...

We report a case of a 59-year-old male in post-myocardial infarction cardiogenic shock undergoing left atrial venous arterial extracorporeal membrane oxygenation (LAVA-ECMO) as a bridge to transplantation. The unique feature of this ECMO configuration is use of a single trans-septal cannula to provide biventricular unloading and use of a single art...

Cardiogenic shock (CS) is associated with significant morbidity and mortality. Differentiating the etiologic factors driving CS has epidemiological significance and aids in optimization of therapeutic strategies, prognostication and resource utilization. The aim herein is to investigate the epidemiology and clinical outcomes of cardiogenic shock in...

Background Limited data exist regarding complication rates of implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy devices (CRT-D) in patients with left ventricular assist devices (LVAD). Objective We describe the incidence and characteristics of ICD- and CRT-D-related procedures and complications in a multicenter LV...

Background Cardiogenic shock complicated by biventricular (BIV) heart failure is associated with high mortality. Venous-arterial extra-corporeal membrane oxygenation is limited by the increase of left ventricular (LV) afterload. Complex configurations of paired circulatory support devices have been used with mixed results due to vascular access com...

Females have increased risk of right-ventricular failure (RVF) and 3 month mortality after left-ventricular assist device (LVAD) implantation. In this translational study, we tested the hypothesis that sex differences in outcomes are driven by pump-induced LV size-volume mismatch, due to a negative impact on interventricular septal (IVS) interdepen...

Background The Society of Thoracic Surgeons (STS) Intermacs Registry represents a real-world data source of durable, left ventricular assist devices that can address knowledge gaps not informed through randomized clinical trials. We sought to compare survival with contemporary left ventricular assist device technologies using multiple analytic appr...

Introduction Traditionally, implantation of Left Ventricular Assist Devices (LVADs) is performed via median sternotomy. Recently, less invasive thoracotomy approaches are growing in popularity as they involve less surgical trauma, potentially less bleeding, and may preserve right ventricular function. We hypothesized implantation of LVADs via thora...

Background Prior studies have shown that women have worse 3‐month survival after receiving a left ventricular assist device compared with men. Currently used prognostic scores, including the Heartmate II Risk Score, do not account for the increased residual risk in women. We used the IMACS (International Society for Heart and Lung Transplantation M...

Myocarditis can be refractory to medical therapy and require durable mechanical circulatory support (MCS). The characteristics and outcomes of these patients are not known. We identified all patients with clinically-diagnosed or pathology proven myocarditis who underwent mechanical circulatory support in the International Society for Heart and Lung...

Introduction: Prior studies have shown that females have worse 3-month survival post-LVAD. Currently used prognostic scores including the Heartmate II Risk Score (HMRS), were developed in >75% male cohorts, and may not account for the increased residual risk in females. Hypothesis: A sex-specific risk score will predict post-LVAD mortality in femal...

Introduction Cardiovascular comorbidities confer worse outcomes for patients with Coronavirus disease 2019 (COVID-19), but the impact of heart failure (HF) with preserved (HFpEF) and reduced (HFrEF) ejection fraction has not been well characterized. The aim herein is to examine outcomes in COVID-19 patients with and without HF. Methods Patients (n...

Introduction Right ventricular failure (RVF) after LVAD implantation is associated with increased morbidity and mortality. Despite several RVF predictive models, poor performance in external validation cohorts has limited their widespread clinical adoption. Objective To develop a novel RVF predictive model, ascertain its performance in an independ...

A chronic immunosuppressed state as in solid organ transplant recipients is a reported risk factor for the novel 2019 coronavirus infection. Patients with a history of orthotopic heart transplant (OHT) at a tertiary care transplant center in Detroit, Michigan were retrospectively reviewed from March until May 2020. Clinical parameters and outcomes...

Introduction Regional outcomes after implantation of continuous flow left ventricular assist devices (LVAD) have not been described. We examined differences in patient selection, survival and adverse events (AEs) across three geographic regions of the World: Americas (Am), Asia-Pacific (AP) and Europe (Eu). Methods Using data from The Internationa...

Background The field of mechanical circulatory support has been impacted by the approval of new continuous-flow left ventricular assist devices (LVADs) and changes to the United States heart allocation system. Methods Primary isolated continuous-flow LVAD implants in The Society of Thoracic Surgeons Intermacs registry from January 2014 through Sep...

The number of patients with left ventricular assist devices (LVAD) has increased over the years and it is important to identify the etiologies for hospital admission, as well as the costs, length of stay and in-hospital complications in this patient group. Using the National Readmission Database from 2010 to 2015, we identified patients with a hist...

Cardiogenic shock (CS) is an urgent state of cardiac insufficiency associated with high morbidity and mortality that can complicate many cardiac conditions. Timely diagnosis and rapid intervention are required to restore cardiac output and end-organ perfusion before irreversible multisystem dysfunction and activation of the systemic inflammatory re...

Purpose of Review In this review, we discuss risk assessment of advanced heart failure (HF) patients as a referral guide for advanced HF therapies, including left ventricular assist device (LVAD) support and cardiac transplant. Recent Findings The frequency of LVAD implantation for the purpose of permanent “destination” therapy is growing and surv...

Randomized controlled trials can provide optimal clinical evidence to assess the benefits of new devices, and it is these data that often shape device usage in real-world practice. However, individual clinical trial results sometimes appear discordant for the same device, and alternative devices are sometimes not employed in similar patient populat...

Background Various risk models with differing discriminatory power and predictive accuracy have been used to predict right ventricular failure (RVF) after left ventricular assist device (LVAD) placement. There remains an unmet need for a contemporary risk score for continuous flow (CF)‐LVADs. We sought to independently validate and compare existing...

Background: Long-term survivors after implantation of left ventricular assist devices (LVADs) are increasing in prevalence. We describe the characteristics and outcomes in patients surviving longer than 4 years on LVAD support. Methods: We performed a multicenter, retrospective analysis of patients surviving at least 4 years on continuous-flow L...

Introduction: Patients with continuous flow Left Ventricular Assist Devices (LVAD) and concomitant Cardiac Implantable Electrical Devices (CIED) are prone for device and lead-related complications requiring intervention. Hypothesis: We evaluated the incidence and characteristics of CIED-related procedures and complications and their association wit...

Continuous-flow left ventricular assist devices (CF-LVADs) have revolutionized the management of patients with advanced heart failure. Alternative implant strategies are increasingly used for device placement. We reviewed our experience from the Mechanical Circulatory Support Research Network registry with the HeartWare centrifugal CF-LVAD (HVAD)....

Background: Device indications have changed for placement of continuous-flow left ventricular assist devices (CF-LVADs). We performed a multicenter analysis evaluating temporal variations in outcomes after CF-LVAD implantation. Methods & results: We retrospectively defined three time intervals to reflect changes in CF-LVAD technology (Period 1:...

Durability of the percutaneous driveline is critical for the optimal long-term support of patients after left ventricular assist device (LVAD) implantation. There are no data specifically examining the durability of major repair for driveline fracture or its effect on patient outcomes.Between May 2004 and August 2014, 560 patients underwent implant...

Background: Earlier studies have demonstrated disparities in patients undergoing left ventricular assist device (LVAD) implantation when stratified according to sex and race. Because very few data exist from large investigations, we reviewed data from the registry of the Mechanical Circulatory Support Research Network. Methods: Between May 2004...

Background: Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) patient profiles and modifiers are descriptors of patient illness severity before durable ventricular assist device implantation. It is unknown how individual U.S. institutions and practitioners assign profiles and if modifiers improve on risk discrimination...

Objectives: We review differences in the incidence and timing of adverse events in patients implanted with continuous-flow left ventricular assist devices (LVADs), using the Mechanical Circulatory Support Research Network registry. Methods: From May 2004 to September 2014, a total of 734 patients (591 men; median age: 59 years) underwent primary...

Infection is a major source of morbidity and mortality after ventricular assist device (VAD) implantation. The percutaneous driveline is the most common site of infection in these patients and often serves as a portal to deeper pump infections. There are no data defining the role of prophylactic antibiotics in preventing these infections. We compar...

Modern left ventricular assist devices (LVAD) require anti-coagulation (AC) with warfarin and anti-platelet therapy to prevent thromboembolic complications in patients. Gastrointestinal bleeding (GI) is a significant adverse event in these patients and treatment typically requires reduction or elimination of AC or anti-platelet therapy. It is not k...

Left ventricular assist device therapy (LVAD) is effective management for advanced heart failure. INTERMACS data suggests increased early mortality in older recipients, but similar intermediate-term outcome among early survivors. We analyzed results of LVAD therapy in pt between 65 and 70 years and compared their outcomes with younger pt from our c...

Because there are very little data specifically examining whether differences exist in clinical characteristics and outcomes with regard to sex and race in patients undergoing implantation of continuous flow left ventricular assist device (LVAD), we have reviewed our experience.Methods and MaterialsWe studied 342 pt who underwent HeartMate II impla...

Background: Patients are being supported for longer periods with implantable left ventricular assist devices (LVADs) owing to longer transplantation wait times and approval of LVADs for destination therapy. This comes with an increased potential need for device exchange when complications arise. There are few data examining this patient population...

Delayed sternal closure (DSC) is employed after conventional cardiac surgery without a significantly increased risk of late mediastinitis or sternal wound infection. There are no data specifically examining its late effects on patients undergoing implantation with a ventricular assist device (VAD). Between October 1996 and October 2010, 364 patient...