Search

Frailty and malnutrition in patients with heart failure are barriers to durable left ventricular assist device (D-LVAD) support and heart transplantation. Moreover, cachexia in patients with advanced heart failure carries a high mortality risk. There are no guidelines for these patients other than increased caloric intake and rehabilitation. Patients suffering from cardiac cachexia and heart failure may benefit from temporary, percutaneous assist device support to improve the underlying heart disease and reverse the catabolic state. We retrospectively reviewed patients from January 2017 to January 2022. All patients who received Impella support (5.0 or 5.5, Abiomed) before D-LVAD implantation were screened. Those who met the criteria for cardiac cachexia were included. Patient demographics, nutritional and biochemical markers, and survival data were collected. A total of 14 patients were included. The majority of patients were male (85.7%) with ischemic cardiomyopathy (64.3%). Caloric intake, physical strength, and ambulation improved. Prealbumin levels improved from a median of 13.7-18.0 mg/dl ( p < 0.006) while on Impella 5.0 or 5.5 support. All patients survived to discharge and the 6 month follow-up. In conclusion, use of the Impella device improves cardiogenic shock symptoms and, consequently, may improve cachexia status prior to D-LVAD implantation., (Copyright © ASAIO 2023.)

Background: Yearly rate and mean patient age of left ventricular assist device (LVAD) implantation increased from 2009 to 2014. Data are lacking regarding trends of LVAD implantation in older adults., Objectives: To describe the trends of LVAD implantation in older adults and the clinical impact of associated procedural complications., Methods: We retrospectively analyzed the National Inpatient Sample from 2005 to 2014, calculated the percentage of older adults (>65 years of age) among those who underwent LVAD implantation, and compared their clinical characteristics. Primary outcomes were in-hospital mortality and discharge home., Results: In total, 4491 patients were included. The percentage of older adults among those receiving LVAD increased from 12.53% to 31.65% (p<0.01). Older adults were more likely to develop postoperative delirium (17.90% vs. 11.92% in younger patients; p<0.01), which portended lesser odds of discharge home., Conclusions: Delirium develops with greater incidence in older adults undergoing LVAD implantation, which decreases odds of favorable discharge disposition., Competing Interests: Declaration of Competing Interest BA, SK, SN, IAS, BK, and IDG all report receiving in-kind support from medical companies for travel and lodging, food and beverage, and education. All transactions are reported on the OpenPayments website in accordance with the Sunshine Act, and none rise to the level of a conflict of interest., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Dysfunction of different components within continuous-flow (CF) left ventricular assist device (LVAD) systems may cause adverse cardiovascular and end-organ sequelae. Outflow graft obstruction is a recognized type of LVAD component dysfunction. Ten patients were admitted and treated for LVAD outflow graft obstruction. Two of these patients subsequently developed recurrent outflow graft obstruction requiring reintervention; however, each reoccurrence was at a different site than the original obstruction. Thus, a total of 12 cases of obstruction were analyzed. The most common reasons for hospital admission were low flow LVAD alarms or decompensated heart failure. Presentation with outflow graft obstruction occurred an average of 3.0 years after LVAD implantation. Patients underwent echocardiographic evaluation at the time of admission. Left ventricular assist device component dysfunction was suspected based on echocardiographic findings, and follow-up contrast studies were used to establish the specific diagnosis of outflow graft stenosis. The majority of stenotic lesions (10/12) were treated percutaneously with balloon angioplasty and stenting with balloon-expandable endovascular prostheses. Postintervention, all patients had significant improvement in LVAD flow rates.

Heart failure is becoming increasingly prevalent, and more patients are being treated with left ventricular assist devices (LVADs), either as a bridge to transplant or as destination therapy. The use of continuous-flow LVADs is on the rise. LVAD therapy is associated with several classes of complications, including bleeding, thrombosis, and infection. CT imaging can be used effectively to diagnose LVAD complications, including mediastinal hematomas and pericardial, abdominal wall, and retroperitoneal hemorrhage, inflow and outflow graft and aortic thrombi, and driveline and pump pocket infections. CT can also be helpful in cases of device malfunction and can detect outflow graft kinking and inflow cannula misalignment. When interpreting CT scans in patients with LVADs, accessory materials implanted with the device should not be mistaken for hemorrhage or calcification. With training in recognizing LVAD complications, radiologists can play an important role in the evaluation of patients with heart failure., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Congestive heart failure is one of the leading causes of morbidity and mortality in the United States, and left ventricular assist devices have revolutionized treatment of end-stage heart failure. Given that sleep apnea results in significant morbidity in these patients with advanced heart failure, practicing sleep physicians need to have an understanding of left ventricular assist devices. In this review, we summarize what is known about ventricular assist devices as they relate to sleep medicine., (Copyright © 2016 Elsevier Ltd. All rights reserved.)