Outcomes of elective versus emergent permanent mechanical circulatory support in the elderly: a single-center experience.

Background: Advanced age is considered a relative contraindication to heart transplantation, but there is no published consensus on critical age in the case of mechanical circulatory support (MCS). This single-center study investigated outcomes of elective versus emergent implementation of permanent MCS in the elderly.

Methods: Between January 1, 2006 and April 1, 2009, 31 patients, >65 years of age, were supported with a ventricular assist device (VAD), intended for permanent support, at our institution.

Heart transplantation at the Deutsches Herzzentrum Berlin.

The Deutsches Herzzentrum Berlin is one of the largest transplant centers in Germany with more than 1700 transplant procedures, more than 170 being procedures in children, in patients from the beginning of life to 71 years of age. Survival rates during the early and intermediate follow-up are lower than in international data; however, long-term survival at 15 years or more is similar. Discrepant survival rates derive mainly from the organ shortage that resulted in the development of a different allocation system in Germany as compared to North America and in the increasing number of patients undergoing the bridge-to-transplant concept to move the patient to transplantability.

Right ventricular failure after left ventricular assist device implantation with concomitant pulmonary embolectomy needing right ventricular assist device support in a patient with terminal heart failure and asymptomatic pulmonary thrombus.

We present a case in which a left ventricular assist device (LVAD) was implanted in a patient with terminal heart failure and preoperatively diagnosed asymptomatic thrombus in the right pulmonary artery. LVAD implantation was performed with concomitant thromboembolectomy in deep hypothermic circulatory arrest (DHCA) and intra-operatively right ventricular assist device (RVAD) implantation for the treatment of acute right ventricular failure became necessary. The patient was weaned from the RVAD after eight days of support.

Levitronix CentriMag to Berlin Heart Excor: a "bridge to bridge" solution in refractory cardiogenic shock.

Levitronix CentriMag is a third generation bearingless temporary rotary pump designed for short-term mechanical support. The device, combined with Berlin Heart cannulas, was implanted in 30 patients suffering from acute cardiogenic shock with biventricular failure. Fifteen patients were successfully bridged to long-term Excor support due to lack of myocardial recovery.

Tricuspid incompetence and geometry of the right ventricle as predictors of right ventricular function after implantation of a left ventricular assist device.

Background: Implantation of a left ventricular assist device (LVAD) is an established treatment for end-stage heart failure. Right ventricular (RV) dysfunction develops in 20% to 50% of patients after LVAD implantation, leading to prolonged ICU stay and elevated mortality. However, the prediction of RV failure remains difficult.

Prediction of cardiac stability after weaning from left ventricular assist devices in patients with idiopathic dilated cardiomyopathy.

Background: During ventricular assist device (VAD) unloading, cardiac recovery is possible even in patients with chronic heart failure (HF). We sought parameters predictive of cardiac stability after VAD removal.

Methods And Results: Among 81 patients weaned since March 1995, a homogenous group of 35 with idiopathic dilated cardiomyopathy weaned from left VADs was selected.

Body mass index and outcome after ventricular assist device placement.

Background: The implantation of ventricular assist devices (VAD) is an established treatment for end-stage congestive heart failure. Extremes of body mass index (BMI) are associated with decreased survival after cardiac surgery. Many patients with congestive heart failure develop cardiac cachexia.

Experience with over 1000 implanted ventricular assist devices.

Purpose: The use of ventricular assist devices (VADs) in patients with chronic end-stage or acute heart failure has led to improved survival. We present our experience since 1987.

Subjects And Methods: Between July 1987 and December 2006, 1026 VADs were implanted in 970 patients.

Intramyocardial delivery of bone marrow mononuclear cells and mechanical assist device implantation in patients with end-stage cardiomyopathy.

In end-stage heart failure, mechanical ventricular assist devices (VAD) are being used as bridge-to-transplantation, as a bridge-to-recovery, or as the definitive therapy. We tested the hypothesis that myocardial implantation of autologous bone marrow mononuclear cells (BMNC) increases the likelihood of successful weaning from left VAD (LVAD) support. Ten patients (aged 14-60 years) with deteriorating heart function underwent LVAD implantation and concomitant implantation of autologous BMNC.

Unusual tumor in the left ventricular outflow tract.

We report an unusual case of a pseudocyst in the left ventricular outflow tract in a 58-year-old woman. The cyst was successfully resected by a transatrial approach.

Ventricular assist devices in children: current achievements and future perspectives.

Mechanical circulatory support systems for the treatment of acute and chronic heart failure are now available for use in several clinical situations and are designed for different indications and support times. In children, particularly in small infants, extracorporeal membrane oxygenation and centrifugal pumps have been most widely used in the past. These systems are preferred for support after cardiac operations and for use in patients who have concomitant respiratory failure, but they are suitable for short-term application only and intensive care is obligatory.

CO(2) embolism during minimally invasive vein harvesting.

CO(2) embolism is a known, though rare, complication of procedures using CO(2) insufflation. We report massive cardiac right atrial CO(2) embolism during minimally invasive harvesting of a varicose great saphenous vein. The patient's hemodynamics deteriorated significantly and needed to be stabilized by emergency institution of cardiopulmonary bypass.

Impact of heparin-induced thrombocytopenia on outcome in patients with ventricular assist device support: single-institution experience in 358 consecutive patients.

Background: Cardiac surgical patients are at an approximate 1% to 2% risk of experiencing heparin-induced thrombocytopenia (HIT), a severe immune-mediated disease that is associated with thromboembolic events. We assessed the occurrence of this disease and its influence on clinical outcome in patients after implantation of a ventricular assist device (VAD).

Methods: This retrospective analysis assessed data from our adult patient VAD program between the years 2000 and 2005.

Improvement in survival after mechanical circulatory support with pneumatic pulsatile ventricular assist devices in pediatric patients.

Background: Pediatric size pneumatically driven extracorporeal ventricular assist devices (VAD) for infants and small children were introduced into clinical routine in 1992. In the initial period, the results in infants were poor. Since then, several improvements have been introduced with regard to the cannulas, connectors, heparin coating of the blood pump inner surface, anticoagulant treatment and coagulation monitoring, and earlier decision-making in favor of pump implantation before irreversible shock has set in.

Mechanical cardiac support in the young with the Berlin Heart EXCOR pulsatile ventricular assist device: 15 years' experience.

The pediatric-size pneumatically driven pulsatile extracorporeal ventricular assist device (VAD) Berlin Heart EXCOR (Berlin Heart Mediprodukt GmbH, Berlin, Germany) was introduced into clinical practice by the German Heart Institute Berlin in 1992. Until July 1, 2005, Berlin Heart EXCOR systems have been used for circulatory support in 68 children up to 18 years of age with severe circulatory failure resistant to pharmacologic therapy. These were patients suffering from cardiomyopathy, fulminant myocarditis, end-stage congenital cardiac defects, and acute heart failure following congenital heart surgery.

Patients supported for over 4 years with left ventricular assist devices.

Ventricular assist device implantation has become an established therapy in adults and children for bridging to heart transplantation or to aid myocardial recovery. Recently, implantation of left ventricular assist devices as definitive therapy has been recognized as a better option than pharmacological treatment in patients who are not candidates for heart transplantation. This study presents our institution's experience with five patients successfully supported by two different left ventricular assist devices for over 4 years.

Long-term results in patients with idiopathic dilated cardiomyopathy after weaning from left ventricular assist devices.

Background: Since our first successful left ventricular assist device (LVAD) explantation in a patient with idiopathic dilated cardiomyopathy (IDCM) in 1995, an additional 31 IDCM patients have been weaned in our department. Echocardiographic evaluations during repeated "off-pump" trials were the cornerstone for weaning decisions. After 9 years of experience, we assessed the reliability of our weaning criteria in light of the long-term results.

Natriuretic peptides and E-selectin as predictors of acute deterioration in patients with inotrope-dependent heart failure.

Objective: In patients with inotrope-dependent end-stage heart failure the timely application of the most suitable treatment, i.e. heart transplantation, implantation of a ventricular assist device or conservative treatment, is a key issue for therapeutic success.

Organ-specific regulation of pro-inflammatory molecules in heart, lung, and kidney following brain death.

Background: Nonspecific inflammatory events following brain death may increase the intensity of the immunological host response. The present study investigated the course of pro-inflammatory molecules in heart, lung, kidney, and plasma after brain death induction.

Materials And Methods: Brain death was induced in five pigs by inflation of an intracranial Foley catheter and five pigs were sham-operated as controls.