The progress of mechanical circulatory support devices / 中国胸心血管外科临床杂志

@#As a global disease, heart failure affects at least 26 million people, and its prevalence is still rising. Besides, the mortality rate and readmission rate remain high. Advanced heart failure is the terminal stage of various heart diseases, and often requires some treatments other than drug intervention, such as heart transplantation which is the gold standard for treatment of heart failure. However, limited by the number of donors, the number of heart transplants in the world has reached a bottleneck. There is a huge gap between the number of patients who need heart transplants and patients who get hearts for survival successfully in reality. With the exploration and development of mechanical circulation support devices for more than half a century, they have become a wonderful treatment for patients with advanced heart failure. This article will introduce the latest progress of mechanical circulatory support devices at home and abroad from the aspects of temporary and long-term devices.

Early reduction of pulmonary arterial hypertension in patients using a long-term mechanical ventricular assistance device: a cross-sectional study

ABSTRACT BACKGROUND: Severe pulmonary arterial hypertension (PAH) is a contraindication for heart transplantation (HT). It has been correlated with increased early and late mortality, mainly associated with right ventricular failure. Ventricular assistance devices (VADs) can promote reduction of intracardiac pressures and consequent reduction of PAH over the medium and long terms, thus enabling future candidature for HT. The diminution of early pulmonary pressure within this scenario remains unclear. OBJECTIVE: To evaluate the reduction of PAH and correlate data from right catheterization with the earliness of this reduction. DESIGN AND SETTING: Cross-sectional study in a general hospital in São Paulo, Brazil. METHODS: This was a retrospective analysis on the medical records of patients undergoing VAD implantation in a single hospital. Patients for whom VAD had been indicated as a bridge to candidature for HT due to their condition of constant PAH were selected. RESULTS: Four patients with VADs had constantly severe PAH. Their mean pulmonary artery systolic pressure (PASP) before VAD implantation was 66 mmHg. Over the 30-day period after the procedure, all the patients evolved with a drop in PASP to below 60 mmHg. Their new average was 36 mmHg, which was a drop of close to 50% from baseline values. The one-year survival of this sample was 100%. CONCLUSION: VAD implantation can reduce PAH levels. Early reduction occurred in all patients. Thus, use of VAD is an important bridge tool for enabling candidature for HT among patients with constantly severe PAH.

Dispositivos de asistencia ventricular en el shock cardiogénico posinfarto: importancia del soporte hemodinámico: reporte de caso / Ventricular assist devices in post-infarction cardiogenic shock: importance of hemodynamic support: case report / Dispositivos de assistência ventricular no choque cardiogênico pós-infarto: importância do suporte hemodinâmico: relato de caso

El shock cardiogénico posinfarto caracterizado por un estado de insuficiencia circulatoria sistémica requiere de un tratamiento precoz en vistas a restablecer la estabilidad hemodinámica y la función ventricular. Este consta de la reperfusión coronaria mediante revascularización miocárdica; en algunos casos es necesaria la utilización de dispositivos de asistencia ventricular. El ECMO venoarterial es un sistema de circulación extracorpórea que permite un soporte biventricular oxigenando la sangre y reintroduciéndola mediante un flujo continuo hacia la circulación arterial sistémica. El uso de dicho dispositivo en pacientes con shock cardiogénico ha mostrado una mejoría significativa de la sobrevida a 30 días en comparación con el uso del balón de contrapulsación intraaórtico. No obstante, sus potenciales complicaciones, como dificultad en el vaciamiento ventricular izquierdo, síndrome de Arlequín, sangrados e infecciones, hacen fundamental la formación y el trabajo en equipo del heart team. Un porcentaje no menor de estos pacientes presentarán una severa disfunción ventricular permanente, por lo que podrían ser candidatos a dispositivos de asistencia ventricular izquierda de larga duración tipo Heartmate III como puente al trasplante cardíaco, el cual ha mostrado resultados satisfactorios con una excelente sobrevida a mediano plazo.

Post-infarction cardiogenic shock characterized by a state of systemic circulatory failure requires early treatment in order to restore hemodynamic stability and ventricular function. This consists of coronary reperfusion through myocardial revascularization, requiring in some cases the use of ventricular assist devices. Veno-arterial ECMO is an extracorporeal circulation system that allows biventricular support by oxygenating the blood and reintroducing it through a continuous flow towards the systemic arterial circulation. The use of this device in patients with cardiogenic shock has shown a significant improvement in survival at 30 days compared to the use of intra-aortic balloon pump. However, its potential complications, such as difficulty in left ventricular emptying, Harlequin syndrome, bleeding and infections, make the training and teamwork of the heart team essential. A great percentage of these patients will present a severe permanent ventricular dysfunction, so they could be candidates for long-term mechanical circulatory support devices like Heartmate III as a bridge to transplant or myocardial recovery, or destination therapy, which has shown satisfactory results with excellent medium-term survival.

O choque cardiogênico pós-infarto caracterizado por um estado de insuficiência circulatória sistêmica requer tratamento precoce para restabelecer a estabilidade hemodinâmica e a função ventricular. Esta consiste na reperfusão coronariana por meio de revascularização miocárdica, necessitando, em alguns casos, do uso de dispositivos de assistência ventricular. A ECMO venoarterial é um sistema de circulação extracorpórea que permite o suporte biventricular oxigenando o sangue e reintroduzindo-o através de um fluxo contínuo para a circulação arterial sistêmica. O uso desse dispositivo em pacientes com choque cardiogênico mostrou melhora significativa na sobrevida em 30 dias em relação ao uso de contrapulsação com balão intra-aórtico. No entanto, suas potenciais complicações, como dificuldade de esvaziamento ventricular esquerdo, síndrome de Harlequin, sangramentos e infecções, tornam imprescindível o treinamento e o trabalho em equipe do time do coração. Não uma pequena porcentagem desses pacientes apresentará uma condição ventricular permanente grave, podendo ser candidatos a dispositivos de assistência ventricular esquerda de longa duração do tipo Heartmate III como ponte para o transplante cardíaco, que tem demonstrado resultados satisfatórios com excelente sobrevida em médio prazo.

Left Ventricular Assist Device Thrombosis: Combined Approach by Echocardiography and Logfiles Review for Diagnosis and Management

ABSTRACT Introduction: Left ventricular assist devices are an established therapy for end-stage heart failure. Follow-up of these patients showed complications, such as thrombosis. Our objective was to evaluate the contribution of echocardiography — in association with HeartWare HVAD online logfiles reviews and lactate dehydrogenase titration — for diagnosis and treatment of thrombosis. Methods: Seventeen episodes of thrombosis were diagnosed in 8/20 patients with HVAD. Diagnosis was made by trans-thoracic echocardiographic blood flow velocities, logfiles review of power consumption and pump flows, and titration of lactate dehydrogenase. Data were collected at baseline routine control (Group A), during thrombosis (Group B), after thrombolysis (Group C). Results: Thrombolysis was successful in all cases; one patient died of cerebral haemorrhage. Echocardiographic maximal blood flow velocity near the inflow cannula was 598±42 cm/sec (Group B), 379.41±21 cm/sec (Group C), and 378.24±28 cm/sec (Group A) (P<0.00001). In eight (47%) cases, thrombi were visualized in the left ventricle by three-dimensional modality. Logfiles recordings of blood flows were 9.52±0.9 L/min (Group B), 4.02±0.4 L/min (Group C), and 4.04±0.4 L/min (Group A) (P<00001). Power consumption was 5.01±0.7 W (Group B), 3.45±0.2 W (Group C), and 3.46±0.2 W (Group A) (P<0.00001). Lactate dehydrogenase was 756±54 IU (Group B), 234±22 IU (Group A), and 257±36 IU (Group C) (P<0.00001). Conclusions: Echocardiography of increased maximal velocity near the inflow cannula is a sign of HVAD obstruction. Logfile reviews provide a clear picture of HVAD obstruction. Combination of echocardiographic data and review of logfiles detects signs of left ventricular assist devices thrombosis leading to a successful treatment.

Utilización de oxigenación por membrana extracorpórea venoarterial en el shock cardiogénico y paro cardiorrespiratorio refractarios: experiencia inicial de 7 años en un centro de cardiología de adultos / Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock and Cardiac Arrest: An Initial 7-Year Experience in an Adult Cardiology Center

RESUMEN Introducción: La oxigenación por membrana extracorpórea venoarterial (ECMO VA) es una intervención de rescate en pacientes con shock cardiogénico (SC), y paro cardiorrespiratorio (PCR) refractarios a las terapias convencionales. Objetivo: Describir las características, y resumir nuestra experiencia inicial de 7 años de pacientes que requirieron ECMO VA por SC o PCR. Material y métodos: Se realizó un estudio de cohorte unicéntrico. Se analizaron retrospectivamente los pacientes adultos consecutivos que fueron asistidos con ECMO VA por SC o PCR refractarios entre 2014 y 2020 en el ICBA Instituto Cardiovascular. Resultados: Se incluyeron 54 pacientes, (54 ± 12 años). El 36,5% presentó miocardiopatía isquémica, y el 23,1% enfermedad valvular significativa. Las indicaciones para ECMO VA fueron: poscardiotomía (43,4%), SC refractario (28,3%), y falla primaria del injerto (20,8%). La reanimación cardiopulmonar previa a la ECMO VA se realizó en el 18,5%. La canulación fue periférica en el 81,5%, el 83,3% se asistió en INTERMACS 1, y el 87% presentaba balón de contrapulsación intraaórtico. La duración de asistencia en ECMO VA fue de 5,5 días (RIC 2,8-10). La tasa de supervivencia en ECMO VA fue del 63% (37% puente a trasplante cardíaco, y 26% recuperación), y al alta del 42,6%. Las complicaciones más frecuentes fueron: sangrado (61,1%), infección (51,9%), y complicaciones tromboembólicas (46,3%). Conclusión: La ECMO VA como tratamiento del SC o PCR refractarios en nuestro centro presentó una sobrevida aceptable al alta hospitalaria. La ECMO VA es un tratamiento efectivo cuando las terapias convencionales fallan, siendo aparentemente útil y aplicable en un país donde existe acceso limitado a los dispositivos de asistencia ventricular compleja.

ABSTRACT Background: Venoarterial extra corporeal membrane oxygenation (VA-ECMO) is a rescue intervention used in patients with cardiogenic shock (CS) or cardiac arrest (CA) refractory to conventional medical therapies. Objective: The aim of the present study is to describe the characteristics and summarize our 7-year experience in patients with CS or CA supported with VA-ECMO. Methods: We conducted a single-center retrospective study analyzing consecutive adult patients requiring VA-ECMO due to refractory CS or CA at ICBA, Instituto Cardiovascular between January 2014 and December 2020. Results: A total age 54 patients were included (54 ± 12 years), 36.5% presented ischemic cardiomyopathy and 23.1% significant valvular heart disease. The indications for VA-ECMO implantation were post-cardiotomy (43.4%), refractory CS (28.3%) and primary graft dysfunction (20.8%). Cardiopulmonary resuscitation before VA-ECMO occurred in 18.5% of the cases. Peripheral cannulation was performed in 81.5% of the cases, 83.3% had INTERMACS profile 1 and 87% were on intraaortic balloon pump. Duration of ventricular assistance on VA- ECMO was 5.5 days (IQR 2.8-10). Survival rate on ECMO VA was 63% (37% as a bridge to cardiac transplantation and 26% as a bridge to recovery) and survival to discharge was 42.6%. The most common complications were hemorrhage (61.1%), infections (51.9%), and thromboembolic complications (46.3%). Conclusion: In our center, VA-ECMO as a treatment for refractory CS or CA showed acceptable survival during ventricular support and on hospital discharge. It is an effective life support treatment to rescue critically ill patients when conventional therapies fail, is apparently useful and can be implemented in a country with limited resources and access to complex ventricular assist devices.

Use of CentriMag for refractory cardiogenic shock in a puerperal woman: case report

ABSTRACT CONTEXT: Heart failure in Brazil is a major public health problem and, even with advances in treatment, it still presents high morbidity and mortality. As a treatment option, mechanical circulatory assist devices (MCADs) have greatly increased in importance over the last decade. CASE REPORT: This report concerns a case of refractory cardiogenic shock due to acute myocarditis in a 35-year-old puerperal female patient who presented with retrosternal pain, fatigue and dyspnea. At the hospital, she was diagnosed with myocarditis. There was no improvement in perfusion even after receiving dobutamine, intra-aortic balloon passage (IAB) and venoarterial extracorporeal membrane oxygenation (VA-ECMO). Therefore, it was decided to implant a MCAD (CentriMag). During hospitalization, recovery from the bi-ventricular dysfunction was achieved. The CentriMag device was removed 10 days after it had been implanted, and the patient was discharged after another 8 days. The myocarditis was proven to be due to the Coxsackie virus. CONCLUSIONS: The decision to implant a MCAD should be individualized, as patient profiles do not always match the indications in the guidelines and protocols. In this study, clinical discussion of the case among the medical and multi-professional teams was essential in order to be able to successfully reverse the patient's severe clinical condition without sequelae, through using a CentriMag implant.

Primer implante exitoso de asistencia ventricular izquierda HeartMate 3TM como terapia de destino en Argentina. Revisión de la literatura / First successful Heartmate 3TM left ventricular assist device implantation as destination therapy in Argentina

RESUMEN Se presenta el primer implante exitoso de asistencia ventricular izquierda como terapia de destino mediante el dispositivo de flujo continuo centrífugo con levitación magnética intracorpóreo HeartMate 3TM (Abbott) en la Argentina. El dispositivo se implantó en una paciente de 52 años portadora de miocardio no compacto con disfunción ventricular izquierda grave, hipertensión pulmonar, insuficiencia cardíaca avanzada en estadio INTERMACS 3 y contraindicación para trasplante cardíaco debido a títulos elevados de anticuerpos preformados contra el sistema HLA en crossmatch contra panel.

ABSTRACT First case of successful implantation of intracorporeal full magnetically levitated continuous centrifugal flow left ventricular assist device HeartMate 3 Abbott® as destination therapy in Argentina in a female patient, 52-years-old with non compaction cardiomyopathy, severe left ventricular dysfunction, pulmonary hypertension, end-stage heart failure INTERMACS 3 and contraindication for heart transplantation due to high titers of preformed antibodies against the HLA system in panel reactive antibody assay.

Heterotopic heart transplantation as a left ventricular biological assistance: a new two-stage method proposal

Abstract Since Barnard's first heterotopic heart transplant in 1974, Copeland's method has been the greatest contribution to heterotopic transplants but has the drawback of donor's right ventricular atrophy. This new method proposes a modification in the anastomosis of the superior vena cava aiming to pre-serve donor's right ventricular function by decompressing the pulmonary territory and reducing the pulmonary arterial pressure, as a biological ventricular assist device. Finally, a second intervention is proposed, where a "twist" is performed to place the donor's heart in an orthotopic position after re-moval of the native heart. A pioneering research on this method received approval from the ethics committee of the Heart Institute of São Paulo. We believe that this method has the potential to im-prove quality of life in a selected group of patients.

ECMELLA: Uso combinado de dispositivos de asistencia ventricular izquierda en el manejo del shock cardiogénico postinfarto agudo al miocardio / Combined use of left ventricular assist devices in cardiogenic shock. Report of one case

We report a 55-year-old woman with a history of hypothyroidism and type 2 diabetes mellitus who consulted at the emergency room because of intermittent oppressive chest discomfort. At admission, electrocardiogram showed a complete atrioventricular block. A transthoracic echocardiogram disclosed severe left ventricular dysfunction. The patient developed cardiogenic shock that required the installation of the Impella system. An emergency coronary angiography showed an ostial occlusion of the anterior descending artery. Despite successful primary angioplasty, she persisted with refractory shock and progressive hypoxemia. A concomitant connection to the extracorporeal membrane oxygenation system (ECMO) was decided. The support of both devices allowed the stabilization of the patient and the improvement of perfusion parameters.

Erector spinae plane block as a rescue analgesia technique in a patient with HeartMate 3 ventricular assist type device: case report / Bloqueo de plano del músculo erector de la espina como técnica analgésica de rescate en un paciente con asistencia ventricular tipo HeartMate 3: reporte de caso

Abstract Introduction: Heart failure represents a public health problem involving high morbidity and mortality. For advanced stages of the disease the use of ventricular assist devices (VADs) has been implemented as destination therapy. The perioperative management of patients with VADs may result in multiple challenges, with optimal pain management being one of those challenges. Objective: To describe the use of erector spinae plain (ESP) block as a rescue analgesia technique in a patient undergoing HeartMate 3 type VAD implantat. Methods: Case report and subject review. Results: The case discussed is a patient with ischemic cardiomyopathy and severe ventricular dysfunction, undergoing a HeartMate 3 type VAD implant as destination therapy, under general anesthesia and postoperative analgesia protocol with fentanyl and acetaminophen. During the postoperative period the patient developed acute pain of severe intensity (visual analogue scale [VAS]: 8-10/10), that led to the use of a regional rescue technique-ESP block-that showed satisfactory results with optimal analgesia control (VAS: 1-3/10). Conclusion: The ESP block was a safe and effective option as part of a postoperative analgesia strategy for a patient with a HeartMate 3 type VAD implant.

Resumen Introducción: la insuficiencia cardiaca representa un problema de salud pública con alta morbimortalidad. En estadios avanzados se ha implementado el uso de dispositivos de asistencia ventricular (DAV) como terapia destino. El manejo perioperatorio de pacientes con DAV puede generar múltiples retos, dentro de los cuales se destaca el manejo óptimo del dolor. Objetivo: describir el uso del bloqueo del plano del musculo erector de la espina (ESP) como técnica analgésica de rescate en un paciente llevado a implante de DAV tipo HeartMate 3. Métodos: reporte de caso y revisión de tema. Resultados: se presenta el caso de un paciente con cardiopatía isquémica y disfunción ventricular severa, que fue llevado a un implante de DAV tipo HeartMate 3 como terapia destino, bajo anestesia general y protocolo de analgesia postoperatoria con fentanil y acetaminofén. Durante el posoperatorio presentó dolor agudo de intensidad severa (Escala Visual Análoga: 8-10/10), por lo que se aplicó una técnica regional de rescate: bloqueo ESP, la cual mostró resultados satisfactorios con control analgésico óptimo (Escala Visual Análoga: 1-3/10). Conclusiones: el bloqueo ESP fue una opción segura y efectiva como parte de una estrategia analgésica postoperatoria para un paciente con implante de un DAV tipo HeartMate 3.

Echocardiography in evaluating effect of left ventricular assist devices on perioperative right ventricular function / 中国医学影像技术

End-stage heart failure (HF) is a clinical syndrome in various heart diseases developed to end-stage with high morbidity and mortality. Heart transplantation is deemed as the only valid method for sufferers with end-stage HF, but implantation of left ventricular assist device (LVAD) has become an important treatment for HF patients at the end-stage for the critical shortage of cardiac donors. Right ventricular failure frequently occurred after LVAD implantation. Early identifying right ventricular failure after LVAD implanted has been an important clinical problem. The research progresses of echocardiography for evaluation on right ventricular function perioperative LVAD implantation were reviewed in this article.

Dispositivos de asistencia ventricular en insuficiencia cardíaca avanzada

La insuficiencia cardíaca (IC) continúa siendo una enfermedad de alta prevalencia, afectando al 1-2% de la población en países desarrollados y constituye por ello un problema de salud por los altos costos que esto conlleva. A pesar de los avances en el tratamiento farmacológico y mediante dispositivos implantables presenta un pronóstico pobre. Aproximadamente un 5% de los pacientes con diagnóstico de IC se hallan en un estadio avanzado de la enfermedad o estadio D. En las últimas tres décadas el trasplante cardíaco (TC) se ha convertido en el tratamiento de elección para este grupo de altísimo riesgo. Desafortunadamente, un pequeño porcentaje de pacientes cumple con la edad adecuada y con la ausencia de comorbilidades necesarias para poder acceder a este tratamiento, además de la limitante de la escasez de donantes en la actualidad. Debido a ello y a las largas listas de espera a nivel mundial, cada vez es mayor el desarrollo y la utilización de dispositivos de asistencia ventricular (DAV), que han mejorado la supervivencia a corto y largo plazo, dada la calidad de vida de pacientes con esta grave afección, generando una reducción progresiva de la tasa de complicaciones. Estos beneficios no solo aportan una alternativa a pacientes que esperan un TC, sino que permiten a aquellos con contraindicaciones reversibles a disponer del tiempo y la oportunidad de convertirse en candidatos adecuados, o en caso de que esto no sea posible, su final utilización como terapia de destino. Aun así son muchas las limitaciones de estos dispositivos: su costo, su durabilidad, la tasa de complicaciones y su aplicación a un espectro limitado de pacientes. El avance tecnológico para paliar las complicaciones, la mayor experiencia en los centros de manejo y su generalización para permitir un costo más reducido son estrategias que permitirán que la utilización de DAV en los pacientes con IC avanzada se continúe afianzando.

Heart failure (HF) continues to be a highly prevalent disease, affecting 1-2% of the population in developed countries and is therefore a health problem due to the high costs that this entails. Despite advances in pharmacological treatment and implantable devices, it has a poor prognosis. Approximately 5% of patients diagnosed with HF are in an advanced stage of the disease or stage D. In the last three decades, heart transplantation (HT) has become the treatment of choice for this group of very high risk. Unfortunately, a small percentage of patients meet the appropriate age and the absence of comorbidities necessary to access this treatment, in addition to the limitation of the shortage of donors at present. Due to this and the long waiting lists worldwide, the development and use of ventricular assist devices (VAD), which have improved short and long-term survival, due to the quality of life of patients with This serious condition, generating a progressive reduction in the rate of complications. These benefits not only provide an alternative for patients waiting for a HT, but also allow those with reversible contraindications to have the time and opportunity to become suitable candidates, or in case this is not possible, their final use as therapy of destiny. Even so, there are many limitations of these devices: their cost, their durability, the rate of complications and their application to a limited spectrum of patients. The technological advance to alleviate the complications, the greater experience in the centers of management and its generalization to allow a lower cost are strategies that will allow the use of VAD in patients with advanced HF to continue strengthening.

A insuficiência cardíaca (IC) continua a ser uma doença altamente prevalente, afetando 1-2% da população nos países desenvolvidos e, portanto, é um problema de saúde devido aos altos custos que isso acarreta. Apesar dos avanços no tratamento farmacológico e dispositivos implantáveis, tem um mau prognóstico. Aproximadamente 5% dos pacientes com diagnóstico de IC estão em estágio avançado da doença ou estágio D. Nas últimas três décadas, o transplante cardíaco (TC) tornou-se o tratamento de escolha para esse grupo de risco muito alto. Infelizmente, uma pequena porcentagem de pacientes atinge a idade adequada e a ausência de comorbidades necessárias para acessar esse tratamento, além da limitação da falta de doadores no momento. Devido a isso e as longas listas de espera em todo o mundo, o desenvolvimento e uso de dispositivos de assistência ventricular (DAV), que melhoraram a sobrevivência a curto e longo prazo, devido à qualidade de vida dos pacientes com Esta condição séria, gerando uma redução progressiva na taxa de complicações. Esses benefícios não apenas fornecem uma alternativa para pacientes que aguardam um TC, mas também permitem que aqueles com contraindicações reversíveis tenham tempo e oportunidade de se tornarem candidatos adequados ou, caso isso não seja possível, seu uso final como terapia. de destino. Mesmo assim, existem muitas limitações desses dispositivos: seu custo, sua durabilidade, a taxa de complicações e sua aplicação a um espectro limitado de pacientes. O avanço tecnológico para aliviar as complicações, a maior experiência nos centros de gestão e sua generalização para permitir um menor custo são estratégias que permitirão que o uso do DAV em pacientes com IC avançada continue fortalecendo-se.

Left ventricular assist device implantation combined with bentall procedure

Abstract Ventricular assist devices (VADs) are an important technological development for patients with end-stage heart failure, and approximately 50% of these patients require various additional cardiac procedures. Here we presente the case of a patient suffering from severe aortic insufficiency, aortic root dilatation, and an ascending aortic aneurysm with end-stage decompensated heart failure. We performed the Bentall procedure combined with a left VAD implantation during the same session. The postoperative period was uneventful for this patient, and he was discharged on the 32nd postoperative day. The heart failure symptoms of the patient are reasonable, and he is still on the heart transplantation waiting list.

Anesthetic Management for Cardiac Tamponade in Patient with LVAD / 계명의대학술지

When pericardial tamponade occurs to the left ventricular assist device (LVAD) implanted patients, typical hemodynamic signs of tamponade such as tachycardia and pulsus paradoxus may be masked by LVAD action. For those with normal heart, anesthetic management during pericardial tamponade operation before drainage is to restrict fluid administration and maintain perfusion pressure with vasopressor are recommended. But the things to concern are different in cases of patient with LVAD. Here, we describe a case of performing anesthesia with LVAD implanted patient for pericardial tamponade operation. A 58-year-old male with HeartWare™ (Medtronic, Framingham, MA, USA) LVAD implant was referred for cardiac tamponade surgery. After the induction of general anesthesia, his mean arterial pressure (MAP) decreased to 38 mmHg with device flow 1.8 L/min and device power 2.4 Watts at pump speed 2,400 RPM. Norepinephrine and Epinephrine infusion were initiated. MAP recovered to 70mmHg with device flow 3.7 L/min and power 3.0 Watts after the drainage of 1,200 cc of pericardial fluid. Cardiac tamponade with LVAD implanted patient present with decreased peak flow, mean flow and decreased pulsatility. LVAD flow depends on pump rotation, preload and afterload. In order to maintain flow in these patients, prevention of preload reduction is important. Since LVAD implantation becoming more popular as Bridge to transplantation and destination therapy, it is important for anesthesiologist to understand the LVAD parameters and factors that affect.

Comunicação efetiva para o cuidado seguro ao paciente com implante de dispositivo de assistência ventricular / Comunicación efectiva para el cuidado seguro al paciente con implante de dispositivo ventricular / Effective communication for the safe care of patients with ventricular assist device implantation

Resumo OBJETIVO Relatar a atuação da equipe multidisciplinar na comunicação efetiva e no cuidado seguro aos pacientes com dispositivo de assistência ventricular. MÉTODO Relato de experiência sobre o uso da comunicação efetiva no cuidado a pacientes com dispositivo de assistência ventricular em hospital universitário do sul do Brasil. A referida assistência iniciou em 2017, pautada na individualização das ações e na perspectiva do cuidado centrado no paciente. RESULTADOS Na instituição foram capacitadas equipes multiprofissionais, estruturados protocolos assistenciais, realizadas sessões educativas sistemáticas para pacientes e cuidadores. Foram executadas visitas domiciliares para planejamento de alta hospitalar e plano para situações de urgência, além de capacitações básicas para as equipes dos hospitais próximos à residência dos pacientes. CONCLUSÕES A comunicação efetiva entre equipe multiprofissional, pacientes e cuidadores no planejamento do cuidado em saúde tem papel fundamental para identificar precocemente possíveis complicações, preveni-las e possibilitar maior sobrevida e qualidade de vida a esses pacientes.

Resumen OBJETIVO Informar la actuación del equipo multidisciplinario en la comunicación efectiva y cuidado seguro a los pacientes con dispositivo de asistencia ventricular. MÉTODO Se trata de un relato de experiencia sobre el uso de la comunicación efectiva en la asistencia a pacientes con dispositivo de asistencia ventricular em un hospital universitario del sur de Brasil. Esse cuidado, inició en 2017, pautado em la individualización de las acciones y em la perspectiva del cuidado centrado em el paciente. RESULTADOS En la institución se capacitaron equipos multiprofissionales, estructurados protocolos asistenciales, realizadas sesiones educativas sistemáticas para pacientes y cuidadores, visita domiciliares para la planificación de alta hospitalaria y plan para situaciones de urgência, además de capaccitaciones de urgência, además de capacitaciones básicas para los equipos de los hospitales cercanos a la residencia de los pacientes. CONCLUSIONES La comunicación efectiva entre el equipo multiprofesional, pacientes y familiares en la planificación del cuidado en salud tiene un papel fundamental para identificar precozmente posibles complicaciones, prevenirlas y posibilitar mayor sobrevida y calidad de vida.

Abstract OBJECTIVE To report the role of multiprofessional teams in the effective communication and safe care of patients with left ventricular assist device. METHODS This is an experience report about the use of effective communication for patients with ventricular assist device in a university hospital in southern Brazil. Care based on individualized action and centered on the patients started in 2017. RESULTS At the institution, the multiprofessional teams attended training sessions and care protocols were established. The patients and caregivers attended systematic educational sessions and home visits were made to arrange patient discharge and urgency plans. Also, the hospital teams located near the patients' homes received basic training. CONCLUSION Effective communication between multiprofessional teams, patients, and their families when planning care plays a pivotal role in the early identification of possible complications and their prevention, resulting in a greater survival rate and a better quality of life.

Rational use of mechanical circulatory support as a bridge to pediatric and congenital heart transplantation

Abstract Introduction: Donor shortage and organ allocation is the main problem in pediatric heart transplant. Mechanical circulatory support is known to increase waiting list survival, but it is not routinely used in pediatric programs in Latin America. Methods: All patients listed for heart transplant and supported by a mechanical circulatory support between January 2012 and March 2016 were included in this retrospective single-center study. The endpoints were mechanical circulatory support time, complications, heart transplant survival and discharge from the hospital. Results: Twenty-nine patients from our waiting list were assessed. Twelve (45%) patients were initially supported by extracorporeal membrane oxygenation (ECMO) and a centrifugal pump was implanted in 17 (55%) patients. Five patients initially supported by ECMO were bridged to another device. One was bridged to a centrifugal pump and four were bridged to Berlin Heart Excor®. Among the 29 supported patients, 18 (62%) managed to have a heart transplant. Thirty-day survival period after heart transplant was 56% (10 patients). Median support duration was 12 days (interquartile range [IQR] 4 - 26 days) per run and the waiting time for heart transplant was 9.5 days (IQR 2.5-25 days). Acute kidney injury was identified as a mortality predictor (OR=22.6 [CI=1.04-494.6]; P=0.04). Conclusion: Mechanical circulatory support was able to bridge most INTERMACS 1 and 2 pediatric patients to transplant with an acceptable complication rate. Acute renal failure increased mortality after mechanical circulatory support in our experience.

Recomendaciones de manejo de pacientes con asistencia circulatoria mecánica de corta duración / Recommendations for the management of patients with short-term mechanical circulatory assistance

There has been a progressive increase in the use of mechanical circulatory support in our country in the last years, mainly in the short-term: as a bridge to cardiac transplant or recovery, which has allowed to rescue patients from a population that concentrates high rates of complications and mortality. This motivated that the Ministry of Health convened a series of experts in the area of heart failure, transplantation and mechanical circulatory support, representatives of different public and private health centers in Chile, with the objective of developing recommendations on the use of short-term mechanical assistance devices, which would serve as a reference for the proper management of these patients. This clinical experts consensus document contains topics related to: definitions and general concepts; indications; contraindications; specific aspects of starting, follow-up and weaning of the devices; process of transfer of patients in circulatory assistance from one center to another and finally criteria of organization, means and competences to be fulfilled by the centers that offer this therapeutic option.

A Survey on the Use of External Medications and Injection Drugs Conducted by Persons Visiting in a Health Insurance Pharmacy / 社会薬学

Since attention is sometimes required with regard to the use and handling of external medications or injection drugs in drug therapy, patients may have a feeling of “inconvenience”. We, therefore, focused on a feeling of “inconvenience when using” external medications and injection drugs, and conducted a questionnaire survey to investigate the level of awareness and current status of using assist devices that can effectively reduce such inconvenience. The survey took place at a pharmacy, and involved interviews using a questionnaire. Of the 197 respondents, valid responses were obtained from 147 individuals (74.6%). As the results, 25.9% of individuals using external medications or injection drugs responded ‘yes’ concerning the feeling of “inconvenience when using” them. In addition, 39.4% of individuals using eye drops and 10.5% of those using insulin similarly responded. However, only 10.9% knew of the availability of assist devices that are expected to reduce the inconvenience. The results revealed that a certain number of people feel the “inconvenience” of external dosage forms investigated in this study, suggesting the need for pharmacists to consider that patients may have problems using their medications, and to recommend and support the use of assist devices that can be operated by patients.

A Survey on the Use of External Medications and Injection Drugs Conducted by Persons Visiting in a Health Insurance Pharmacy / 社会薬学

Since attention is sometimes required with regard to the use and handling of external medications or injection drugs in drug therapy, patients may have a feeling of “inconvenience”. We, therefore, focused on a feeling of “inconvenience when using” external medications and injection drugs, and conducted a questionnaire survey to investigate the level of awareness and current status of using assist devices that can effectively reduce such inconvenience. The survey took place at a pharmacy, and involved interviews using a questionnaire. Of the 197 respondents, valid responses were obtained from 147 individuals (74.6%). As the results, 25.9% of individuals using external medications or injection drugs responded ‘yes’ concerning the feeling of “inconvenience when using” them. In addition, 39.4% of individuals using eye drops and 10.5% of those using insulin similarly responded. However, only 10.9% knew of the availability of assist devices that are expected to reduce the inconvenience. The results revealed that a certain number of people feel the “inconvenience” of external dosage forms investigated in this study, suggesting the need for pharmacists to consider that patients may have problems using their medications, and to recommend and support the use of assist devices that can be operated by patients.

A rare cause of left ventricular assist device (lvad) obstruction: left atrial dissection

Abstract Left atrial dissection is a rare factor that may cause left ventricular assist device obstruction. Prompt diagnosis and surgical repair are essential. This case report describes our experience and a successful surgical management in a patient after HeartMate 3 implantation and mitral valve inflow obstruction due to a left atrial dissection.