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Granfeldt, Hans
Publications (10 of 32) Show all publications
Sundbom, P., Ahn, H., Kornhall, B., Loebe, M. & Granfeldt, H. (2014). (556) – Change in Acoustic Fingerprints at Increased Pump Speed During Echocardiographic Ramp Test. In: : . Paper presented at 34th Annual Meeting and Scientific Sessions of the International-Society-for-Heart-and-Lung-Transplantation (pp. S206). Elsevier, 32(4S)
Open this publication in new window or tab >>(556) – Change in Acoustic Fingerprints at Increased Pump Speed During Echocardiographic Ramp Test
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2014 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Purpose

The continuous flow mechanical circulatory support HeartMate II (Thoratec Corporation, Inc. Pleasanton, USA) (HMII), generates an auditory signal (acoustic fingerprint) that can be registered by routine auscultation. A temporary or permanent change in sound indicates a change in pump function. Previous mock loop studies have shown that changes in acoustic fingerprint are due to changes in speed, so the aim of this study was to see if the acoustic fingerprint changed during an echocardiographic ramp test.

Methods

Four stable, event-free patients included in the SoundMate study performed an echocardiographic ramp test. The speed was increased stepwise by 400 rpm between 8 000 and 12 000 rpm, and the left ventricular end diastolic diameter, flow, power consumption and blood pressure were measured. Sounds from HMII were recorded using an iPhone™ (Apple Inc. Cupertino, CA, USA) with the stethoscope application iStethPro™ (Dr. Peter J Bentley, UK) and the frequency map analyzed using the Audacity™ program (Unicode, Ash, Chinen and Crook, USA). The acoustic fingerprint is divided into regions (R1: 1 000-6 500, R2: 8 500-14 000, R3: 15 000-21 000 Hz) and peaks (P1: 0-1 000, P2: 6 500-8 500, P4: 21 000-23 000 Hz) in order to facilitate calculations and clarify changes in frequency.

Results

There were significant (p<005) changes in the acoustic fingerprint when increasing the pump speed between 8 000 and 12 000 rpm. In 2/4 patients there were no significant changes in P1, otherwise there were significant changes in all regions and peaks. During the ramp test the power increased in mean 7 W, flow 3,1 L/min and the blood pressure measured with Doppler increased by ~15 mmHg. The left ventricular size decreased with ~2 cm.

Conclusion

The acoustic fingerprint changes with pump speed. This implies that when using sound check for detection of pump dysfunction, a new baseline should be set after every adjustment of speed.

Place, publisher, year, edition, pages
Elsevier, 2014
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-114003 (URN)10.1016/j.healun.2014.01.898 (DOI)000333866700557 ()
Conference
34th Annual Meeting and Scientific Sessions of the International-Society-for-Heart-and-Lung-Transplantation
Available from: 2015-02-05 Created: 2015-02-05 Last updated: 2017-06-29
Hubbert, L., Sundbom, P., Loebe, M., Peterzén, B., Granfeldt, H. & Ahn, H. (2014). Acoustic Analysis of a Mechanical Circulatory Support. Artificial Organs, 38(7), 593-598
Open this publication in new window or tab >>Acoustic Analysis of a Mechanical Circulatory Support
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2014 (English)In: Artificial Organs, ISSN 0160-564X, E-ISSN 1525-1594, Vol. 38, no 7, p. 593-598Article in journal (Refereed) Published
Abstract [en]

Mechanical circulatory support technology is continually improving. However, adverse complications do occur with devastating consequences, for example, pump thrombosis that may develop in several parts of the pump system. The aim of this study was to design an experimental clot/thrombosis model to register and analyze acoustic signals from the left ventricular assist device (LVAD) HeartMate II (HMII) (Thoratec Corporation, Inc., Pleasanton, CA, USA) and detect changes in sound signals correlating to clots in the inflow, outflow, and pump housing. Using modern telecom techniques, it was possible to register and analyze the HMII pump-specific acoustic fingerprint in an experimental model of LVAD support using a mock loop. Increase in pump speed significantly (P less than 0.005) changed the acoustic fingerprint at certain frequency (0-23 000 Hz) intervals (regions: R1-3 and peaks: P1,3-4). When the ball valves connected to the tubing were narrowed sequentially by similar to 50% of the inner diameter (to mimic clot in the out-and inflow tubing), the frequency spectrum changed significantly (P less than 0.005) in P1 and P2 and R1 when the outflow tubing was narrowed. This change was not seen to the same extent when the lumen of the ball valve connected to the inflow tube was narrowed by similar to 50%. More significant (P less than 0.005) acoustic changes were detected in P1 and P2 and R1 and R3, with the largest dB figs. in the lower frequency ranges in R1 and P2, when artificial clots and blood clots passed through the pump system. At higher frequencies, a significant change in dB figs. in R3 and P4 was detected when clots passed through the pump system. Acoustic monitoring of pump sounds may become a valuable tool in LVAD surveillance.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2014
Keywords
Mechanical circulatory support; Frequency analysis; Thrombosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-112071 (URN)10.1111/aor.12244 (DOI)000343223400001 ()24372095 (PubMedID)
Available from: 2014-11-14 Created: 2014-11-13 Last updated: 2017-12-05Bibliographically approved
Sundbom, P., Hedayati, E., Peterzén, B., Granfeldt, H., Casimir Ahn, H. & Hübbert, L. (2014). Young Woman With Breast Cancer and Cardiotoxicity With Severe Heart Failure Treated With a HeartMate II (TM) for Nearly 6 Years Before Heart Transplantation. ASAIO journal (1992), 60(6), E3-E4
Open this publication in new window or tab >>Young Woman With Breast Cancer and Cardiotoxicity With Severe Heart Failure Treated With a HeartMate II (TM) for Nearly 6 Years Before Heart Transplantation
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2014 (English)In: ASAIO journal (1992), ISSN 1058-2916, E-ISSN 1538-943X, Vol. 60, no 6, p. E3-E4Article in journal (Refereed) Published
Abstract [en]

Cardiotoxicity is a multifactorial problem, which has emerged with the improvement of cancer therapies and survival. Heart transplantation is relatively contraindicated in patients with breast cancer, until at least 5 years after complete remission. We present a case where a young woman who in 2001, at the age of 31, was diagnosed with breast cancer. She was considered cured, but 4 years later she suffered a relapse. During her second treatment, in 2006, she suffered from severe heart failure. She received a HeartMate II, as a long-term bridge to transplantation and 6 years later she was successfully transplanted. In this case report we discuss the use of mechanical circulatory support in cancer patients with drug-induced heart failure.

Place, publisher, year, edition, pages
Lippincott, Williams andamp; Wilkins, 2014
Keywords
breast cancer; cardiotoxicity; heart failure; mechanical circulatory support; heart transplantation
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-113018 (URN)10.1097/MAT.0000000000000138 (DOI)000345299200001 ()25232773 (PubMedID)
Available from: 2015-01-12 Created: 2015-01-08 Last updated: 2017-12-05
Sundbom, P., Hedayati, E., Peterzén, B., Granfeldt, H., Ahn, H. & Hübbert, L. (2013). Kardiotoxicitet med terminal hjärtsvikt och nästan sex år med Heartmate II i väntan på hjärttransplantation. In: : . Paper presented at Thoraxmötet 2013, 17-18 oktober, Linköping.
Open this publication in new window or tab >>Kardiotoxicitet med terminal hjärtsvikt och nästan sex år med Heartmate II i väntan på hjärttransplantation
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2013 (Swedish)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-104988 (URN)
Conference
Thoraxmötet 2013, 17-18 oktober, Linköping
Available from: 2014-03-05 Created: 2014-03-05 Last updated: 2015-11-09Bibliographically approved
Casimir Ahn, H., Granfeldt, H., Hübbert, L. & Peterzén, B. (2013). Long-term left ventricular support in patients with a mechanical aortic valve. Scandinavian Cardiovascular Journal, 47(4), 236-239
Open this publication in new window or tab >>Long-term left ventricular support in patients with a mechanical aortic valve
2013 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 47, no 4, p. 236-239Article in journal (Refereed) Published
Abstract [en]

Objectives. The presence of a mechanical prosthesis has been regarded as an increased risk of thromboembolic complications and as a relative contraindication for a left ventricular assist device (LVAD). Five patients in our center had a mechanical aortic valve at the time of device implantation and were studied regarding thromboembolic complications. Design. Five patients operated upon with an LVAD (1 HeartMate I (TM), 4 HeartMate II (TM)) between 2002 and 2011 had a mechanical aortic valve at the time of implantation. The first patient had a patch closure of the aortic valve. In four patients, the prosthesis was left in place. Anticoagulants included aspirin, warfarin, and clopidogrel. Results. The average and accumulated treatment times were 150 and 752 days, respectively. Three of the five patients showed early signs of valve thrombosis on echo with concomitant valve dysfunction. Four patients were transplanted without thromboembolic events during pump treatment. One patient died from a hemorrhagic stroke after 90 days on the LVAD. Conclusions. The strategy of leaving a mechanical heart valve in place at the time of LVAD implantation in five patients led to valvular thrombosis in three but did not provoke embolic events. It increased the complexity of postoperative anticoagulation.

Place, publisher, year, edition, pages
INFORMA HEALTHCARE, TELEPHONE HOUSE, 69-77 PAUL STREET, LONDON EC2A 4LQ, ENGLAND, 2013
Keywords
aortic valve, left ventricular support, mechanical valve
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-96976 (URN)10.3109/14017431.2013.795655 (DOI)000322607700007 ()
Available from: 2013-09-05 Created: 2013-09-02 Last updated: 2017-12-06
Engström, A. E., Granfeldt, H., Seybold-Epting, W., Dahm, M., Cocchieri, R., Driessen, A. H., . . . Henriques, J. P. (2013). Mechanical circulatory support with the Impella 5.0 device for postcardiotomy cardiogenic shock: a three-center experience. Minerva Cardioangiologica: Journal on Cardiovascular Pathophysiology, Clinical Medicine and Therapy, 61(5), 539-546
Open this publication in new window or tab >>Mechanical circulatory support with the Impella 5.0 device for postcardiotomy cardiogenic shock: a three-center experience
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2013 (English)In: Minerva Cardioangiologica: Journal on Cardiovascular Pathophysiology, Clinical Medicine and Therapy, ISSN 0026-4725, E-ISSN 1827-1618, Vol. 61, no 5, p. 539-546Article in journal (Refereed) Published
Abstract [en]

AIM:

Postcardiotomy cardiogenic shock (PCCS) is associated with high mortality rates, despite full conventional treatment. Although the results of treatment with surgically implantable ventricular assist devices have been encouraging, the invasiveness of this treatment limits its applicability. Several less invasive devices have been developed, including the Impella system. The objective of this study was to describe our three-center experience with the Impella 5.0 device in the setting of PCCS.

METHODS:

From January 2004 through December 2010, a total of 46 patients were diagnosed with treatment-refractory PCCS and treated with the Impella 5.0 percutaneous left ventricular assist device at three european heart centers. Baseline and follow-up characteristics were collected retrospectively and entered into a dedicated database.

RESULTS:

Within the study cohort of 46 patients, mean logistic and additive EuroSCORES were 24 ± 19 and 10 ± 4. The majority of patients underwent coronary artery bypass grafting (48%) or combined surgery (33%). Half of all patients had been treated with an intra-aortic balloon pump before 5.0-implantation, 1 patient had been treated with an Impella 2.5 device. All patients were on mechanical ventilation and intravenous inotropes. The Kaplan-Meier estimate of overall 30-day survival was 39.5%.

CONCLUSION:

Thirty-day survival rates for patients with PCCS, refractory to aggressive conventional treatment and treated with the Impella 5.0 device, are comparable to those reported in studies evaluating surgically implantable VADs, whereas the Impella system is much less invasive. Therefore, mechanical circulatory support with the Impella 5.0 device is a suitable treatment modality for patients with severe PCCS.

Place, publisher, year, edition, pages
Edizione Minerva Medica, 2013
Keywords
Shock, cardiogenic, Cardiac surgical procedures, Surgical procedures, operative
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-102786 (URN)000327753600005 ()24096248 (PubMedID)
Note

Funding Agencies|Abiomed Europe GmbH||

Available from: 2014-01-07 Created: 2013-12-26 Last updated: 2017-12-06Bibliographically approved
Hubbert, L., Peterzen, B., Granfeldt, H. & Ahn, H. C. (2012). Acoustic Analysis of a Mechanical Circulatory Support in JOURNAL OF HEART AND LUNG TRANSPLANTATION, vol 31, issue 4, pp S250-S250. In: JOURNAL OF HEART AND LUNG TRANSPLANTATION (pp. S250-S250). Elsevier, 31(4)
Open this publication in new window or tab >>Acoustic Analysis of a Mechanical Circulatory Support in JOURNAL OF HEART AND LUNG TRANSPLANTATION, vol 31, issue 4, pp S250-S250
2012 (English)In: JOURNAL OF HEART AND LUNG TRANSPLANTATION, Elsevier , 2012, Vol. 31, no 4, p. S250-S250Conference paper, Published paper (Refereed)
Abstract [en]

n/a

Place, publisher, year, edition, pages
Elsevier, 2012
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-76943 (URN)000302207900731 ()
Available from: 2012-05-02 Created: 2012-04-27 Last updated: 2012-05-02
Hübbert, L., Jorde, U. P., Peterzén, B., Granfeldt, H., Kornhall, B., Morrison, K. & Ahn, H. C. (2012). Early Results from the SoundMate Study. Acoustic Analysis of a Thromboembolic Event in a Patient Treated with HeartMate II (TM), Mechanical Circulatory Support. Paper presented at 32nd Annual Meeting and Scientific Sessions of the International-Society-for-Heart-and-Lung-Transplantation/Meeting of the ISHLT Academy - Core Competencies in Mechanical Circulatory Support, APR 17-21, 2012, Prague, CZECH REPUBLIC. The Journal of Heart and Lung Transplantation, 31(4 Suppl.), S134-S135
Open this publication in new window or tab >>Early Results from the SoundMate Study. Acoustic Analysis of a Thromboembolic Event in a Patient Treated with HeartMate II (TM), Mechanical Circulatory Support
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2012 (English)In: The Journal of Heart and Lung Transplantation, ISSN 1053-2498, E-ISSN 1557-3117, Vol. 31, no 4 Suppl., p. S134-S135Article in journal, Meeting abstract (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2012
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-76942 (URN)10.1016/j.healun.2012.01.388 (DOI)000302207900379 ()
Conference
32nd Annual Meeting and Scientific Sessions of the International-Society-for-Heart-and-Lung-Transplantation/Meeting of the ISHLT Academy - Core Competencies in Mechanical Circulatory Support, APR 17-21, 2012, Prague, CZECH REPUBLIC
Available from: 2012-05-02 Created: 2012-04-27 Last updated: 2017-12-07
Ahn, H., Granfeldt, H., Hübbert, L. & Peterzén, B. (2012). Long-term mechanical circulatory support in patients with a prosthetic aortic valve. Paper presented at 4th Joint Scandinavian Conference in Cardiothoracic Surgery, 16-18 August 2012, Vilnius, Lithuania.
Open this publication in new window or tab >>Long-term mechanical circulatory support in patients with a prosthetic aortic valve
2012 (English)Conference paper, Published paper (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-87606 (URN)
Conference
4th Joint Scandinavian Conference in Cardiothoracic Surgery, 16-18 August 2012, Vilnius, Lithuania
Available from: 2013-01-19 Created: 2013-01-19 Last updated: 2013-02-04
Granfeldt, H. (2010). The use of mechanical circulatory support and passive ventricular constraint in patients with acute and chronic heart failure. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>The use of mechanical circulatory support and passive ventricular constraint in patients with acute and chronic heart failure
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Many patients are diagnosed as having chronic heart failure (CHF) and apart from the fact that daily activities are impaired, they are great consumers of health care, and the prognosis is poor. The distinction between acute heart failure (AHF) and CHF may be difficult and is more a question of time rather than severity. The “gold standard” treatment for end‐stage heart failure is heart transplantation. Due to organ shortage this is reserved for selected patients only. Since the introduction of mechanical circulatory support (MCS) more and more patients with progressive CHF have been bridged‐to‐heart‐transplantation. There are MCS systems available for both short‐ and long‐term support. Newer concepts such as ventricular constraint to prevent ventricular remodelling are on the way. We have investigated short‐ (ImpellaTM) and long‐term (HeartMateTM I and II) MCS and ventricular constraint (CorCapTM CSD) as treatment concepts for all forms of heart failure, the aims being: bridge‐to‐decision, bridge‐to‐transplant and extended therapy, called “destination therapy” (DT).

Methods and results: In Paper I, the use of HM‐ITM pulsatile MCS in bridge‐to‐transplantation patients in Sweden was retrospectively investigated regarding outcome and risk factors for mortality and morbidity. Fifty‐nine patients were treated between 1993 and 2002. The dominating diagnosis was dilated cardiomyopathy in 61%. Median support time was 99.5 days. 18.6% died before transplantation. Four patients needed RV assist due to right ventricular failure. Haemorrhage was an issue. Six patients (10%) suffered a cerebrovascular thromboembolic lesion. 15% developed driveline infection. 45% of the MCS patients were discharged home while on pump treatment. Massive blood transfusion was a predictor for mortality and morbidity, p<0.001.

In Paper II the second generation long‐term MCS, the continuous axial flow pump HM‐IITM, was prospectively evaluated for mortality and morbidity. Eleven patients, from 2005 until 2008, were consecutively included at our institution. One patient received the pump for DT. The median pump time was 155 days. Survival to transplantation was 81.8%. Ten patients could be discharged home before transplantation after a median time of 65 days.

Paper III investigated the Swedish experience and outcome of short‐term axial flow MCS, the ImpellaTM, in patients with AHF. Fifty patients were collected between 2003 and 2007 and divided into two groups: 1. Surgical group (n=33) with cardiogenic shock after cardiac surgery; and 2. Non‐surgical group (n=17), patients with AHF due to acute coronary syndromes with cardiogenic shock (53%) and myocarditis (29%). The 1‐year survival was 36% and 70%, respectively. 52% were reoperated because of bleeding. Predictors for survival at 30 days were preoperatively placed IABP (p=0.01), postoperatively cardiac output at 12 hours and Cardiac Power Output at 6 and 12 hours.

In Paper IV we evaluated the use and long term outcome of ventricular constraint CorCapTM CSD. Since 2003, 26 consecutive patients with chronic progressive heart failure were operated with CSD via sternotomy (n=25) or left mini‐thoracotomy (n=1). Seven patients were operated with CorCapTM only. Nineteen patients had concomitant cardiac surgery. There were three early and three late deaths. The remaining cohort (n=18) was investigated in a cross‐sectional study regarding QoL with SF‐36. There was no difference in QoL measured with SF‐36 after a mean 3‐years follow up period, when compared to an age‐ and sex‐matched control group from the general population. The one‐year survival was 86%, and after three years 76%. Echocardiographic dimensions had improved significantly after three years.

Conclusion: In our unit, a non‐transplanting medium‐sized cardiothoracic department, short‐ and long‐term MCS (ImpellaTM resp. HMTM) in patients with acute or chronic HF have been used with good results. The use of ventricular constraint early in the course of the disease is a good adjunct to other treatment options in progressive chronic HF patients.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2010. p. 68
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1178
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-56424 (URN)9789173934145 (ISBN)
Public defence
2010-06-12, Elsa Brändströmsalen, Universitetssjukhuset, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2010-05-11 Created: 2010-05-11 Last updated: 2017-12-14Bibliographically approved
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