Search

Background: Driveline (DL) damages are a common difficulty among ventricular assist devices (VAD). Repairing the electrical fibers inside the DL on a running pump is hazardous and requires technical expertise, which is not easily available on site. A new feature of the HeartMate3 (Abbott, U.S.A.) LVAD is a modular driveline that allows an easy exchange of the DL cord. In this report we analyze our experiences with this feature. Methods: We performed a retrospective analysis of 302 patients who underwent either HeartMate II or HeartMate 3 implantation between February 2004 and September 2021. Patients were screened for driveline faults and need for exchange or repair of driveline or VAD exchange. Documented were baseline characteristics, reasons for DL or VAD exchange, and complications. Follow‐up was three months after the procedure. Results: We present a cohort of 302 patients who underwent either HMII (n = 107;35.4%) or HM 3 (n = 195; 64.5%) implantation. Out of those, 40 patients (40/302; 13.2%) required driveline repair (DLRe) or exchange (DLEx). Out of 107 HMII patients, 9 showed severe DL damages (9/107; 8.4%). Six patients (6/9; 66.6%) underwent DLRe, two patients (2/6; 33.3%) required VAD exchange after DLRe, one patient (1/2;50%) experienced emergency VAD exchange after pump stop. The DLRe procedure in the other four patients (4/6; 66.6%) was successful. Due to damage to the internal driveline two patients (2/9; 22.2%) underwent emergency device exchange and one patient (1/9;11.1%) was listed for transplantation. 31 out 195 HM3 patients underwent exchange of the modular DL. In none of the cases, damages of the internal fibers were the reasons for the exchange. In 100% of the cases, damages of the external coating were the reason for DL exchange. In none of the cases, complications occurred after the exchange procedure. Conclusions: Driveline damages are a habitual, recurrent complication in VAD patients. The exchange of the modular driveline cable of the HM3 is feasible and safe compared to the conventional DL repair in HMII patients. Risky repair attempts and surgical LVAD exchange due to major damages of the electrical fibers can be avoided successfully by the new feature of HM3 driveline. [ABSTRACT FROM AUTHOR]

This article discusses a rare case of a lightning strike causing damage to a left ventricular assist device (LVAD), a device used to manage end-stage heart failure. The patient's LVAD was connected to a house power source when lightning struck, resulting in dysfunction of the device. The article highlights the vulnerability of electrical devices to external factors such as lightning strikes and emphasizes the importance of proper electrical isolation in the patient's home. The case also suggests the use of percutaneous venoarterial ECMO implantation and LVAD exchange in cases of severe electrical damage to the LVAD. The article concludes by emphasizing the need for physicians to remain vigilant and prepared for unexpected challenges in managing LVAD patients. [Extracted from the article]

Objectives: Historically, females were described as suffering from worse outcomes after left ventricular assist device (LVAD) implantation. However, females' preoperative conditions are unique, making direct comparisons with males challenging. This study aimed to select through propensity score (PS) matching two preoperatively comparable populations of females and males and test if any real sex‐related difference exists regarding survival and adverse events after LVAD implantation. Methods: This retrospective single‐center observational study investigated patients who received LVAD implantation between 2010 and 2018. PS matching was applied to balance preoperative heterogeneity between males and females. Primary endpoint was survival at follow‐up. Secondary endpoints included perioperative outcomes and LVAD‐related adverse events. Results: 92 fully comparable females(n = 46) and males(n = 46) were selected after PS matching (median age:57 years, min–max:18–75). 26.1% of patients required preoperative mechanical circulatory support. Females needed more intraoperative fresh frozen plasma (p < 0.001) and platelets transfusions (p = 0.008) compared to males, but postoperative outcomes were comparable between groups. In‐hospital, 1 and 2‐year survival were 78.3%, 69.6% and 65.2%, respectively, with no differences between groups. Survival probability remained comparable up to 8 years of follow‐up (p = 0.35). Overall, females showed a higher rate of strokes (p = 0.039) compared to males in the follow‐up time. Conclusions: After reducing preoperative heterogeneity between females and males, survival after LVAD implantation does not differ based on sex. However, differences might exist in terms of higher transfusions and strokes in females. Reducing preoperative sex disparities and developing intraoperative and anticoagulation strategies which acknowledge sex‐related variations might help abolishing differences in LVAD outcomes. [ABSTRACT FROM AUTHOR]

An intra‐cavitary left ventricular (LV) thrombus is a relative contraindication to LV assist device (LVAD) implantation based on increased thromboembolic risks. Herein, we present our experience with LVAD patients with or without preoperative diagnosis of LV‐thrombus. We retrospectively investigated 563 patients who received LVAD implantation between 2004 and 2018. Diagnosis of LV‐thrombus was verified with computed tomography scan, magnetic resonance imaging, echocardiography, or intraoperative LV inspection. The primary endpoint was 30‐day survival free of stroke and pump thrombosis. Overall, 72 patients (12.8%) had a diagnosis of LV‐thrombus. They were younger (51 years; IQR:41‐59), affected by severely reduced ejection fraction (15%; IQR:10‐20), more often presenting with dilated cardiomyopathy (61.8%) and INTERMACS profile 1 (33.3%). Preoperative atrial fibrillation was frequent in patients without LV‐thrombus (38.9%). Conventional sternotomy was the preferred approach in LV‐thrombus patients (77.8%), based on more HMII implantations in these patients (41.7%). Survival free of strokes and pump thrombosis at 30 days was comparable (P =.5751) between patients with (83.3%) or without LV‐thrombus (80.9%). LVAD implantation in patients with preoperative LV‐thrombus is safe and feasible. When managed through correct diagnostic and intraoperative strategies including accurate inspection of the LV cavity, these patients show similar 30‐day outcomes compared to patients without LV‐thrombus. [ABSTRACT FROM AUTHOR]

Literature on the air travel activities of patients supported by permanent mechanical assist devices is rare. To the best of our knowledge, no air travel guidelines or fitness prerequisites exist on whether and when ventricular assist device (VAD) patients are allowed to travel by plane after device implantation. In this study, we evaluated the topic of air travel after VAD implantation. This working group aimed to produce a report on air travel passengers supported by VADs, regarding their fitness to fly. Fifty left ventricular assist device (LVAD) patients were surveyed in a worldwide multicenter study. The single survey was performed with a multimethod design, including interviews conducted face‐to‐face, online, and on phone. Out of 50 patients, 97% described their traveling by aircraft as perfect and uneventful during the flight. Eighty‐five percent of the study participants consulted their medical practitioner before the flight. No patient reported the occurrence of a severe condition associated with flying. LVAD alarms, especially low flow alarms, did not occur in any of the devices. Thirty‐five percent of the surveyed patients, however, stated a major problem pertaining to the security check procedures at the airport. The results of this study suggest that commercial air travel is safe for stable patients on permanent VAD support and traveling can be resumed securely after VAD implantation. Conscientious preparation by packing necessary devices, fluids, medications, and careful preparation for the airport security check is recommended. [ABSTRACT FROM AUTHOR]

The quality of the machined surface resulted from the electrical discharge machining (EDM) environment is not efficient according to the previous studies. One of the significant problems is the impedance of dielectric fluid, where it is contributing to focusing the plasma channel in a limited area. Hence, this behavior leads to appearing deep craters on the machined zone. The researchers have attempted to enhance the average of surface roughness by employing powder particles or surfactant as the additive materials in the dielectric fluid. Unfortunately, these studies did not present a comparison between these additive materials in this environment. Therefore, the present study aims to compare the performance of the average of surface roughness (Ra) for AISI D2 steel by utilizing Nano chromium powder (NCP) and Span‐20. The present work has proved that the behavior of the average of surface roughness for this steel is dropping at the maximum level of Nano chromium powder concentration and pulse duration as compared to the behavior with the Span‐20. Moreover, the best roughness was produced by this steel with Nano chromium powder at 2 g/L and 20 μs for this powder and the pulse duration. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion The study assesses the feasibility of the DuoCor BiVAS, a novel biventricular assist system integrating magnetic levitation technology.In an acute large animal model involving five sheep, each received the DuoCor BiVAS without cardiopulmonary bypass. Hemodynamic and device parameters were monitored continuously for 1‐h post‐implantation.Intraoperative implantation was uneventful, demonstrating successful biventricular support with mean blood flows of 5.4 LPM (left) and 5.5 LPM (right). Analysis showed proportional flow rates and relationships between pump speed, flow, and power consumption. No adverse events like thrombus formation, bleeding, stroke, or device failure occurred.This research underscores the DuoCor BiVAS's potential for severe biventricular heart failure treatment, providing insights into its feasibility and functionality in acute animal models. The findings suggest promising clinical applications, particularly with the system's single driveline design potentially enhancing patient mobilization and quality of life. Further investigations are needed to advance this technology for broader clinical use. [ABSTRACT FROM AUTHOR]