Less Invasive Approach to Left Ventricular Assist Device Implantation May Improve Survival in High-Risk Patients.

Objective: Despite improvement in outcomes after left ventricular assist device (LVAD) implantation over the past 2 decades, high-risk recipients continue to have a prohibitive rate of morbidity and mortality. We hypothesized that a less invasive approach to LVAD implantation would be associated with improved survival compared to a conventional approach in this high-risk cohort.

Methods: All consecutive LVAD recipients (2013 to 2017) that underwent centrifugal LVAD implantation were retrospectively reviewed.

Outcomes of obese patients undergoing less invasive LVAD implantation.

Background: Obesity and heart failure rates continue to rise, confronting heart failure centers with challenging left ventricular assist device (LVAD) implantations. Although less invasive approaches to implantation have been successfully implemented by many centers, this surgical approach has not yet been well evaluated in the obese population. Therefore, we sought to describe our experience with less invasive device implantation in this patient cohort.

Less invasive left ventricular assist device implantation may reduce right ventricular failure.

Objectives: Right ventricular (RV) failure after left ventricular assist device (LVAD) implantation continues to be a morbid complication. In this study, we hypothesized that a less invasive approach to implantation would preserve RV function relative to a conventional sternotomy (CS) approach.

Methods: All patients (2013-2017) who underwent LVAD implantation were reviewed.

Minimally Invasive Left Ventricular Assist Device Implantation: Implementation Early in a Surgical Career.

Objective: Several centers have presented minimally invasive surgical approaches to centrifugal left ventricular assist device implantation. Although minimally invasive implantation has been successfully performed by experienced surgeons, at large implanting centers, it is unknown whether these techniques are widely adoptable. We evaluated the experience of a surgeon early in his career with conventional and minimally invasive approaches to device implantation.

Individualized Antithrombotic Therapy in Heartware HVAD Recipients.

There are no evidence-based guidelines for antithrombotic therapy in left ventricular assist device patients. We evaluated the efficacy of a multi-agent, test-guided protocol, which remained consistent throughout our use of the Heartware HVAD. Thrombelastography and platelet function analyzer (PFA)-100 guide antiplatelet titration.

Ex Vivo Assessment of a Parabolic-Tip Inflow Cannula for Pediatric Continuous-Flow VADs.

To address the challenge of unloading the left ventricle during pediatric mechanical circulatory support using next-generation rotary blood pumps, a novel inflow cannula was developed. This unique inflow cannula for pediatric, continuous-flow, left ventricular assist devices (VADs) with a parabolic-shaped inlet entrance was evaluated alongside a bevel-tip and fenestrated-tip cannula via an ex vivo, isolated-heart experimental setup. Performance was characterized using two clinical scenarios of over-pumping and hypovolemia, created by varying pump speed and filling preload pressure, respectively, at ideal and off-axis cannula placement to assess ventricular unloading and positional sensitivity.

Assessing the influence of health on rural outmigration in Alaska.

Objectives: This formative study is intended to generate questions and hypotheses regarding the relationship between health and outmigration from Alaska's rural communities. This study is the first to provide perspectives of rural Alaskans in the context of health concerns and health care delivery as determinants of outmigration.

Study Design: The study collected secondary data through a comprehensive review of the literature and primary data through semi-structured interviews.