scholarly journals Isovolumic loading of the failing heart by intraventricular placement of a spring expander attenuates cardiac atrophy after heterotopic heart transplantation

2018 ◽  
Vol 38 (3) ◽  
Author(s):  
Martin Pokorný ◽  
Iveta Mrázová ◽  
Jan Šochman ◽  
Vojtěch Melenovský ◽  
Jiří Malý ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Weight Ratio ◽  
Volume Overload ◽  
Advanced Heart Failure ◽  
Common Complication ◽  
Assist Device ◽  
Time Points ◽  
Cardiac Atrophy ◽  
Heterotopic Heart Transplantation ◽  
Control Heart

Cardiac atrophy is the most common complication of prolonged application of the left ventricle (LV) assist device (LVAD) in patients with advanced heart failure (HF). Our aim was to evaluate the course of unloading-induced cardiac atrophy in rats with failing hearts, and to examine if increased isovolumic loading obtained by intraventricular implantation of an especially designed spring expander would attenuate this process. Heterotopic abdominal heart transplantation (HTx) was used as a rat model of heart unloading. HF was induced by volume overload achieved by creation of the aorto-caval fistula (ACF). The degree of cardiac atrophy was assessed as the weight ratio of the heterotopically transplanted heart (HW) to the control heart. Isovolumic loading was increased by intraventricular implantation of a stainless steel three-branch spring expander. The course of cardiac atrophy was evaluated on days 7, 14, 21, and 28 after HTx. Seven days unloading by HTx in failing hearts sufficed to substantially decrease the HW (−59 ± 3%), the decrease progressed when measured on days 14, 21, and 28 after HTx. Implantation of the spring expander significantly reduced the decreases in whole HW at all the time points (−39 ± 3 compared with −59 ± 3, −52 ± 2 compared with −69 ± 3, −51 ± 2 compared with –71 ± 2, and −44 ± 2 compared with −71 ± 3%, respectively; P<0.05 in each case). We conclude that the enhanced isovolumic heart loading obtained by implantation of the spring expander attenuates the development of unloading-induced cardiac atrophy in the failing rat heart.

scholarly journals Intraventricular placement of a spring expander does not attenuate cardiac atrophy of the healthy heart induced by unloading via heterotopic heart transplantation

2019 ◽  
pp. 567-580 ◽  
Author(s):  
J. Pokorný ◽  
I. Mrázová ◽  
H. Kubátová ◽  
J. Piťha ◽  
J. Malý ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Heart Weight ◽  
Assist Device ◽  
Therapeutic Measure ◽  
Time Points ◽  
Cardiac Atrophy ◽  
Heterotopic Heart Transplantation ◽  
Important Complication ◽  
Patients With Heart Failure

An important complication of the prolonged left ventricle assist device support in patients with heart failure is unloading-induced cardiac atrophy which proved resistant to various treatments. Heterotopic heart transplantation (HTx) is the usual experimental model to study this process. We showed previously that implantation of the newly designed intraventricular spring expander can attenuate the atrophy when examined after HTx in the failing heart (derived from animals with established heart failure). The present study aimed to examine if enhanced isovolumic loading achieved by implantation of the expander would attenuate cardiac post-HTx atrophy also in the healthy heart. Cardiac atrophy was assessed as the ratio of the transplanted-to-native heart weight (HW) and its degree was determined on days 7, 14, 21 and 28 after HTx. The transplantation resulted in 32±3, 46±2, 48±3 and 46±3 % HW loss when measured at the four time points; implantation of the expander had no significant effect on these decreases. We conclude that enhanced isovolumic loading achieved by intraventricular implantation of the expander does not attenuate the development of cardiac atrophy after HTx in the healthy heart. This indicates that such an approach does not represent a useful therapeutic measure to attenuate the development of unloading-induced cardiac atrophy.

scholarly journals Heart Transplant and Ventricular Assist: Cardiac Surgery and Heart Failure Perspective

2021 ◽  
Vol 15 ◽  
Author(s):  
Michael T Cain ◽  
Michael S Firstenberg ◽  
Joseph C Cleveland
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Advanced Heart Failure ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
Ventricular Assistance

For nearly 60 years, there have been two surgical treatment options for individuals with severe advanced heart failure: heart transplantation or implantation of a left ventricular assist device. As these fields have advanced in parallel, improvements in surgical technique, device development, and patient selection have improved outcomes for both therapies. Development of a comprehensive approach to the management of the most severe forms of advanced heart failure requires a deep understanding of both heart transplantation and durable ventricular assistance, including recent advancements in both fields. This article will review the substantial progress in the fields of heart transplantation and mechanical left ventricular assistance, including recent changes to organ allocation prioritization and left ventricular assist device evaluation, both of which have dramatically influenced practice in these fields.

Current Status of the Left Ventricular Assist Device as a Destination Therapy

2016 ◽  
Vol 10 (2) ◽  
pp. 1 ◽  
Author(s):  
Jorge Silva Enciso ◽  
Eric Adler ◽  
Barry Greenberg ◽  
◽  
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Advanced Heart Failure ◽  
Device Therapy ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist

The heart failure epidemic has led to an increase in the number of patients with advanced heart failure, which is associated with high morbidity and mortality. Current therapies for advanced heart failure are limited to heart transplantation and mechanical circulatory support, with palliative care reserved for those ineligible to receive advanced therapies. Clinical trials of ventricular assist devices for patients with advanced heart failure demonstrate an improvement in survival and quality of life akin to heart transplantation. The Achilles heal of this therapy is the adverse event burden. Patient selection and multidisciplinary care are two of the strategies being used to improve long-term outcomes. Adjunct therapies in combination with left ventricular assist device therapy and advances in device technology in the near future may lessen the number of adverse events. This review summarizes the clinical outcomes, current challenges and future directions of left ventricular assist device therapy.

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