Cost‐utility of continuous‐flow ventricular assist devices as bridge to transplant in pediatrics

2019 ◽  
Vol 23 (8) ◽  
Author(s):  
Patrick D. Evers ◽  
Chet Villa ◽  
Samuel G. Wittekind ◽  
Rebecca Hobing ◽  
David L. S. Morales ◽  
...  
Keyword(s):  
Continuous Flow ◽  
Cost Utility ◽  
Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Bridge To Transplant

scholarly journals 1177. A Spectrum of Infectious Complications in Continuous-Flow Ventricular Assist Devices: A Single-Center Longitudinal Cohort

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S421-S422
Author(s):  
Scott C Roberts ◽  
Jonathan D Rich ◽  
Duc T Pham ◽  
Rebecca Harap ◽  
Valentina Stosor
Keyword(s):  
Continuous Flow ◽  
Retrospective Cohort ◽  
Blood Stream ◽  
Ventricular Assist Devices ◽  
Resistant Organism ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Bridge To Transplant ◽  
Time To Onset ◽  
Mean Time

Abstract Background Infections remain a frequent complication of patients (patients) with ventricular assist devices (VAD). We evaluated the epidemiology and outcomes of VAD infections at our center over a 10-year period. Methods We performed a retrospective cohort study of continuous-flow VAD recipients from July 2008-September 2018. VAD-specific and -related infections were characterized according to 2013 ISHLT definitions. Summary and comparative statistics were performed using IBM® SPSS Statistics version 25.0. Results 433 VADs were implanted into 375 patients. A total of 86 VAD infections occurred in 79 patients, with a mean incidence of 0.19 episodes/VAD and 0.20 episodes/pt. Patients with infections were predominantly male (73.3%) and Caucasian (54.6%), and had mean age of 52.7 years, nonischemic cardiomyopathy (58.1%), and VAD as bridge to transplant (53.5%, n = 46). Types of VAD included 43.0% axial (n = 37) and 57.0% centrifugal flow (n = 49). 78% of patients with infections were colonized with at least one multidrug-resistant organism (MDRO) such as MRSA (29%), VRE (73%), and ESBL (24%). Notably, 15% of infections (n = 13) occurred within 60 d of VAD implantation, with mean time to onset 36 d (5–60 d) post-VAD. Early infections (<60d) involved driveline exit site (DLES) (n = 4), pocket (n = 3), and pump (n = 7) with 7 VAD-related blood stream infections (BSI), 6 infective endocarditis (IE), and 2 mediastinitis. Early infections involved Gram-positive (GP) bacteria (84.6%, n = 11), Gram-negatives (GN) (45.5%, n = 5), anaerobes (23.1%, n = 3), fungi (30.8%, n = 4), MDRO (61.5%, n = 8) and 32 pathogens (69.2%, n = 9). 85% of infections occurred late (n = 73) with mean time to onset 338 d (69–1215 d). In late infections (>60d), impacted sites included DLES (n = 38), pocket (n = 7), and pump (n = 40), with 42 BSI, 36 IE, and 2 mediastinitis. Pathogens were 68.5% GP (n = 50), 37.0% GN (n = 27), 2.7% anaerobes (n = 2), 2.7% fungi (n = 2), 17.8% MDRO (n = 13), and 26.0% polymicrobial (n = 19). Conclusion In this longitudinal retrospective cohort of patients supported with VADs, a majority of infections occurred >9 months post-implantation. GP pathogens predominated at all time-points. GN bacteria, including MDROs, anaerobes, and fungi are increasingly encountered. The vast majority of patients were colonized with ³1 MDRO during the course of VAD implantation. Disclosures All authors: No reported disclosures.

scholarly journals Endocrine Challenges in Patients with Continuous-Flow Left Ventricular Assist Devices

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 861
Author(s):  
Gennaro Martucci ◽  
Federico Pappalardo ◽  
Harikesh Subramanian ◽  
Giulia Ingoglia ◽  
Elena Conoscenti ◽  
...  
Keyword(s):  
Continuous Flow ◽  
Left Ventricular ◽  
Endocrine Function ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Endocrine Dysfunction ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist

Heart failure (HF) remains a leading cause of morbidity, hospitalization, and mortality worldwide. Advancement of mechanical circulatory support technology has led to the use of continuous-flow left ventricular assist devices (LVADs), reducing hospitalizations, and improving quality of life and outcomes in advanced HF. Recent studies have highlighted how metabolic and endocrine dysfunction may be a consequence of, or associated with, HF, and may represent a novel (still neglected) therapeutic target in the treatment of HF. On the other hand, it is not clear whether LVAD support, may impact the outcome by also improving organ perfusion as well as improving the neuro-hormonal state of the patients, reducing the endocrine dysfunction. Moreover, endocrine function is likely a major determinant of human homeostasis, and is a key issue in the recovery from critical illness. Care of the endocrine function may contribute to improving cardiac contractility, immune function, as well as infection control, and rehabilitation during and after a LVAD placement. In this review, data on endocrine challenges in patients carrying an LVAD are gathered to highlight pathophysiological states relevant to this setting of patients, and to summarize the current therapeutic suggestions in the treatment of thyroid dysfunction, and vitamin D, erythropoietin and testosterone administration.

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