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Management of patients treated with left ventricular assist devices: A clinical and experimental study
Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis describes the management of patients treated with mechanical circulatory support devices for short- or long-term use. Twenty-four patients suffering from postcardiotomy heart failure were treated with a minimally invasive axial flow pump. The device was effective in unloading the failing left ventricle and in maintaining an adequate systemic circulation. The principles of perioperative monitoring, and pharmacological therapy are outlined. The pump was also used as an alternative to the heart-lung machine in conjunction with coronary artery bypass surgery. Together with a short-acting β-blocker, esmolol, the heart was decompressed and heart motion was reduced, facilitating bypass surgery on the beating heart. The anesthesiological considerations using this method are described.

An implantable left ventricular assist device was used as a bridge to heart transplantation in 10 patients. We were interested in assessing the possibility to establish such a treatment program at a non-transplanting center. A multidisciplinary approach was enabled thanks to the organization of our Heart Center and due the close collaboration with our transplant center at Lund University. As one of the first centers in Europe, we established a well-functioning program with good results. Nine out of 10 of the bridge patients, with treatment times varying between 53 to 873 days, survived pump treatment and were eventually transplanted. The device proved to be powerful enough to support the failing heart and enable rehabilitation of the patients. Outpatient management became simpler when using the electrical device with belt-worn batteries. The uncertain durability and the high risk of device-related complications are shortcomings that limit its potential for more permanent treatment of heart failure.

A new generation of small implantable axial blood flow pumps has therefore been developed. The principles of these pumps are based on the first generation axial flow pumps evaluated in this thesis. After several years of basic research and experimental studies, the first human implants have been performed. In the thesis, the hemodynamic effects of such a novel axial flow pump have been evaluated in an acute heart failure model. This technology holds great promise, both as a bridge to heart transplantation, and as a permanent circulatory support system.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2001. , 79 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 677
Keyword [en]
postcardiotomy heart failure, perioperative monitoring, coronary artery bypass, heart-assist devices, heart failure, congestive, ventricular dysfunction
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-5151ISBN: 91-7219-969-5 (print)OAI: oai:DiVA.org:liu-5151DiVA: diva2:21056
Public defence
2001-05-21, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 00:00 (English)
Opponent
Supervisors
Note
On the day of the public defence the status of the article IV was: Submitted for publication.Available from: 2001-06-12 Created: 2001-06-12 Last updated: 2012-01-24Bibliographically approved
List of papers
1. Postoperative management of patients with Hemopump support after coronary artery bypass grafting
Open this publication in new window or tab >>Postoperative management of patients with Hemopump support after coronary artery bypass grafting
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1996 (English)In: The Annals of thoracic surgery, ISSN 0003-4975, Vol. 62, no 2, 378-385 p.Article in journal (Refereed) Published
Abstract [en]

Background

In this study, we describe postoperative monitoring, pharmacologic therapy, and hemodynamic responses in patients receiving Hemopump support after postcardiotomy heart failure.

Methods

The Hemopump was used in 24 patients with severe left ventricular dysfunction after coronary artery bypass grafting.

Results

Fourteen patients (58%) were weaned from the Hemopump. Low to moderate doses of a combination of catecholamines, phosphodiesterase inhibitors, vasodilators, and vasoconstrictors were required to optimize Hemopump function and left ventricular unloading. Mean arterial blood pressure, mixed venous oxygen saturation, and urinary output were the most important therapy guidelines.

Conclusions

Together with our clinical protocol, the Hemopump effectively unloaded the failing ventricle while maintaining vital-organ perfusion. Doses of vasoactive drugs could be kept low. This approach to treatment provides good conditions for recovery of the stunned myocardium.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13608 (URN)10.1016/0003-4975(96)00241-X (DOI)
Available from: 2001-06-12 Created: 2001-06-12 Last updated: 2009-08-20
2. Anesthetic management of patients undergoing coronary artery bypass grafting with the use of an axial flow pump and a short-acting beta-blocker
Open this publication in new window or tab >>Anesthetic management of patients undergoing coronary artery bypass grafting with the use of an axial flow pump and a short-acting beta-blocker
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1999 (English)In: Journal of cardiothoracic and vascular anesthesia, ISSN 1053-0770, Vol. 13, no 4, 431-436 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To describe the clinical protocol regarding monitoring, pharmacologic interventions, and postoperative care during and after coronary artery bypass grafting (CABG) on the beating heart with an axial flow pump and a short-acting β-blocker.

Design: A retrospective study.

Setting: A university hospital.

Participants: Seventeen patients scheduled for elective CABG.

Interventions: Invasive monitoring was performed with either a standard pulmonary artery catheter (PAC) or a surgically placed PAC. An axial flow pump was inserted through a graft sutured to the ascending aorta. A short-acting β-blocker was administered to decrease the motion of the heart and make conditions for CABG adequate and safe.

Measurements and main results: Compared with baseline measurements, there were significant decreases in mean arterial blood pressure, mixed venous oxygen saturation, and right ventricular ejection fraction during maximal axial flow pump support and β-blockade. No significant change in heart rate was observed at this time. Hemodynamic variables were normalized in the intensive care unit. All patients were separated from the Hemopump without inotropic support, and values of troponin-T, aspartate aminotransferase, and alanine aminotransferase were low postoperatively. All patients survived and were discharged from the hospital.

Conclusion: The anesthetic protocol for patients undergoing surgery with a beating heart and the combined use of an axial flow pump and a short-acting β-blocker is outlined. Multiple-vessel CABG on the beating heart was performed with maintenance of an acceptable hemodynamic situation.

Keyword
coronary artery bypass grafting, beating heart surgery, axial flow pump, β-blocker
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13609 (URN)10.1016/S1053-0770(99)90215-X (DOI)
Available from: 2001-06-12 Created: 2001-06-12 Last updated: 2009-08-20
3. Management of patients with end-stage heart disease treated with an implantable left ventricular assist device in a nontransplanting center
Open this publication in new window or tab >>Management of patients with end-stage heart disease treated with an implantable left ventricular assist device in a nontransplanting center
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2000 (English)In: Journal of cardiothoracic and vascular anesthesia, ISSN 1053-0770, Vol. 14, no 4, 438-443 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To describe the setup of a left ventricular assist device (LVAD) program in a nontransplanting center.

Design: A prospective study from February 1993 to June 1999.

Setting: A university hospital.

Participants: Ten patients, 6 men, with a mean age of 44 years (range 16 to 63 years) and with end-stage heart failure resulting from dilated cardiomyopathy (n = 7) or ischemic heart disease (n = 3).

Interventions: The patients received the TCI (Thermo Cardiosystems Inc, Woburn, MA) Heart Mate implantable assist device. Five patients had a pneumatic device, and 5 had an electric device. All except 1 patient with an electric device had the pump for an extended period.

Measurements and Main Results: Median time on the ventilator was 6.2 days, and median time in the ICU was 14 days. Significant hemodynamic improvement was observed by echocardiography and invasive monitoring. Milrinone and epinephrine supplemented by prostaglandin E1 were the most commonly used drugs to avoid right-sided heart failure. Nine patients were transplanted after pump therapy of 241 days (median) (range, 56 to 873 days). One patient died because of endovascular infection and septicemia. Infectious complications were frequent, especially when the pump time was extended.

Conclusions: The introduction of an LVAD program in a nontransplanting center can be achieved with good results. Intense collaboration with a transplant center is mandatory. The complication rate increased when treatment times were extended.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13610 (URN)10.1053/jcan.2000.7943 (DOI)
Available from: 2001-06-12 Created: 2001-06-12 Last updated: 2013-09-26
4. Long-term follow-up of patients treated with an implantable left ventricular assist device as an extended bridge to heart transplantation
Open this publication in new window or tab >>Long-term follow-up of patients treated with an implantable left ventricular assist device as an extended bridge to heart transplantation
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2002 (English)In: The Journal of Heart and Lung Transplantation, ISSN 1053-2498, Vol. 21, no 5, 604-607 p.Article in journal (Refereed) Published
Abstract [en]

Four patients were given the TCI implantable left ventricular assist device as a bridge to heart transplantation. The median treatment time was 541 days (range 462 to 873 days), with a total of 2,417 treatment days. The patients were followed with exercise tests and echocardiography 3 to 18 months after implantation. An invasive method was used for quantification of inflow valve incompetence.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13611 (URN)10.1016/S1053-2498(01)00372-2 (DOI)
Available from: 2001-06-12 Created: 2001-06-12 Last updated: 2009-08-20
5. Hemodynamic Evaluation of the Jarvik 2000 Heart During Heart Failure
Open this publication in new window or tab >>Hemodynamic Evaluation of the Jarvik 2000 Heart During Heart Failure
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2001 (English)In: ASAIO journal (1992), ISSN 1058-2916, E-ISSN 1538-943X, Vol. 46, no 2, 167- p.Article in journal (Refereed) Published
Abstract [en]

The Jarvik 2000 Heart is an axial flow left ventricular assist system designed for long-term circulatory support. Purpose: To assess the level of hemodynamic support provided by the Jarvik 2000 in an animal model, with acute, severe heart failure. Methods: Heart failure (HF) was induced in 5 calves by progressively ligating the LAD coronary artery. A continuous infusion of esmolol hydrochloride was given to maintain the stability of HF. Compared to normal baseline values, during heart failure CI decreased by 33% (p < 0.02), LAP increased by 16% (p < 0.03), and BP decreased by 28% (p < 0.13). Once stable HF was established, the pump was turned on, and hemodynamic measurements were obtained at pump speed settings that ranged from 8,000 to 12,000 rpm. Results: Selected, mean hemodynamic values are presented in the table, CI, LAP, and BP improved significantly (p < 0.05) at pump speeds >9000 rpm. Pulse pressure (PP) narrowed by 64% (p < 0.009), and the PAP remained unchanged.

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Blood flow in the femoral artery increased but was not statistically significant. Other hemodynamic parameters such as HR, SVR, PVR, and CVP did not change significantly. Conclusions: The Jarvik 2000 Heart can provide a level of cardiac output support that normalizes the CI and LAP, while maintaining some arterial pressure pulsatility during HF. Systemic perfusion is increased while the left heart is unloaded.

Place, publisher, year, edition, pages
Wolters Kluwer, 2001
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-13612 (URN)
Note

The previous status of this article was Manuscript and the titel in manuskript form was Hemodynamic evaluation of the Jarvik 2000 Heart during heart failure in a calf model.

ASAIO Cardiovascular Abstracts.

Available from: 2001-06-12 Created: 2001-06-12 Last updated: 2017-12-13Bibliographically approved

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Peterzén, Bengt

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