This study aimed to comprehensively investigate the essential considerations in designing adaptive clothing for women with lower limb prostheses in Saudi Arabia. Employing a qualitative methodology, the research entai...This study aimed to comprehensively investigate the essential considerations in designing adaptive clothing for women with lower limb prostheses in Saudi Arabia. Employing a qualitative methodology, the research entailed semi-structured, in-depth interviews with women utilizing lower limb prostheses and prosthetic specialists. This approach was selected to unearth pivotal design prerequisites and comprehend the specific challenges these women encounter within the realm of clothing. The utilization of selective sampling facilitated the collection of intricate and valuable insights. A Functional, Expressive, and Aesthetic (FEA) User Needs model was utilized to scrutinize participant feedback. Functional requisites encompass ease of dressing and undressing, accessibility to the prosthetic limb, comfort, mobility with the prosthesis, and appropriate fit. Additionally, participants highlighted various expressive needs, including privacy preservation, modesty, camouflaging disability appearances, maintaining alignment with non-disabled women’s fashion, and considerations about the aesthetic aspects of garments.展开更多
The concept of gait synergy provides novel human-machine interfaces and has been applied to the control of lower limb assistive devices,such as powered prostheses and exoskeletons.Specifically,on the basis of gait syn...The concept of gait synergy provides novel human-machine interfaces and has been applied to the control of lower limb assistive devices,such as powered prostheses and exoskeletons.Specifically,on the basis of gait synergy,the assistive device can generate/predict the appropriate reference trajectories precisely for the affected or missing parts from the motions of sound parts of the patients.Optimal modeling for gait synergy methods that involves optimal combinations of features(inputs)is required to achieve synergic trajectories that improve human–machine interaction.However,previous studies lack thorough discussions on the optimal methods for synergy modeling.In addition,feature selection(FS)that is crucial for reducing data dimensionality and improving modeling quality has often been neglected in previous studies.Here,we comprehensively investigated modeling methods and FS using 4 up-to-date neural networks:sequence-to-sequence(Seq2Seq),long short-term memory(LSTM),recurrent neural network(RNN),and gated recurrent unit(GRU).We also conducted complete FS using 3 commonly used methods:random forest,information gain,and Pearson correlation.Our findings reveal that Seq2Seq(mean absolute error:0.404°and 0.596°,respectively)outperforms LSTM,RNN,and GRU for both interlimb and intralimb synergy modeling.Furthermore,FS is proven to significantly improve Seq2Seq’s modeling performance(P<0.05).FS-Seq2Seq even outperforms methods used in existing studies.Therefore,we propose FSSeq2Seq as a 2-stage strategy for gait synergy modeling in lower limb assistive devices with the aim of achieving synergic and user-adaptive trajectories that improve human-machine interactions.展开更多
While biventricular assist devices(BiVADs)remain underutilized in Western countries for biventricular heart failure(BHF),their application is expanding in China.This consensus synthesizes international guidelines,medi...While biventricular assist devices(BiVADs)remain underutilized in Western countries for biventricular heart failure(BHF),their application is expanding in China.This consensus synthesizes international guidelines,medical evidence,and Chinese clinical expertise to establish standardized protocols for BiVAD management.Key recommendations include:(1)Preoperative right heart catheterization and echocardiography for central venous pressure(CVP):pulmonary capillary wedge pressure(PCWP)ratio and pulmonary artery pulsatility index(PAPi)assessment(Class I);(2)BiVAD indication in refractory BHF or high-risk right heart failure post-left ventricular assist device(LVAD)implantation(Class IIa);(3)Right atrial implantation as the preferred surgical approach(Class IIa);(4)Warfarin-based anticoagulation(INR 2.0–2.5)with aspirin,avoiding direct oral anticoagulants(DOACs)(Class III).The guidance addresses critical gaps in patient selection,pump speed titration,and complication management,positioning integrated BiVAD systems as a promising solution for complex BHF.展开更多
Heart failure has become one of the biggest threats to human health. Transplantation remains the most effective therapy for heart failure, but because of the shortage of donors, it cannot meet the demand. Ventricular ...Heart failure has become one of the biggest threats to human health. Transplantation remains the most effective therapy for heart failure, but because of the shortage of donors, it cannot meet the demand. Ventricular assist devices （VADs） were developed to treat heart failure, and have now been clinically applied worldwide. As the country with the largest population, China is also facing the threat of heart failure. However, the development of VADs in China is very slow and is seldom discussed. This paper first talks about the background for VAD development in China. Then several home-developed VADs in China are introduced. The current clinical application status of VADs in China is also presented. Finally the challenge and opportunity for VAD development in China are discussed.展开更多
Left ventricular assist devices(LVAD)are increasingly become common as life prolonging therapy in patients with advanced heart failure.Current devices are now used as definitive treatment in some patients given the im...Left ventricular assist devices(LVAD)are increasingly become common as life prolonging therapy in patients with advanced heart failure.Current devices are now used as definitive treatment in some patients given the improved durability of continuous flow pumps.Unfortunately,continuous flow LVADs are fraught with complications such as gastrointestinal(GI)bleeding that are primarily attributed to the formation of arteriovenous malformations.With frequent GI bleeding,antiplatelet and anticoagulation therapies are usually discontinued increasing the risk of life-threatening events.Small bowel bleeds account for 15%as the source and patients often undergo multiple endoscopic procedures.Treatment strategies include resuscitative measures and endoscopic therapies.Medical treatment is with octreotide.Novel treatment options include thalidomide,angiotensin converting enzyme inhibitors/angiotensinⅡreceptor blockers,estrogen-based hormonal therapies,doxycycline,desmopressin and bevacizumab.Current research has explored the mechanism of frequent GI bleeds in this population,including destruction of von Willebrand factor,upregulation of tissue factor,vascular endothelial growth factor,tumor necrosis factor-α,tumor growth factor-β,and angiopoetin-2,and downregulation of angiopoetin-1.In addition,healthcare resource utilization is only increasing in this patient population with higher admissions,readmissions,blood product utilization,and endoscopy.While some of the novel endoscopic and medical therapies for LVAD bleeds are still in their development stages,these tools will yet be crucial as the number of LVAD placements will likely only increase in the coming years.展开更多
As cardiac implantable electronic devices(CIED)become more prevalent,it is important to acknowledge potential electromagnetic interference(EMI)from other sources,such as internal and external electronic devices and pr...As cardiac implantable electronic devices(CIED)become more prevalent,it is important to acknowledge potential electromagnetic interference(EMI)from other sources,such as internal and external electronic devices and procedures and its effect on these devices.EMI from other sources can potentially inhibit pacing and trigger shocks in permanent pacemakers(PPM)and implantable cardioverter defibrillators(ICD),respectively.This review analyzes potential EMI amongst CIED and left ventricular assist device,deep brain stimulators,spinal cord stimulators,transcutaneous electrical nerve stimulators,and throughout an array of procedures,such as endoscopy,bronchoscopy,and procedures involving electrocautery.Although there is evidence to support EMI from internal and external devices and during procedures,there is a lack of large multicenter studies,and,as a result,current management guidelines are based primarily on expert opinion and anecdotal experience.We aim to provide a general overview of PPM/ICD function,review documented EMI effect on these devices,and acknowledge current management of CIED interference.展开更多
Ventricular assist devices(VADs)have played an important role in altering the natural history of end-stage heart failure.Low-grade hemolysis has been traditionally described in patients with VADs,indicating effective ...Ventricular assist devices(VADs)have played an important role in altering the natural history of end-stage heart failure.Low-grade hemolysis has been traditionally described in patients with VADs,indicating effective device functionality.However,clinically significant hemolysis could be crucial in terms of prognosis,calling for prompt therapeutic actions.The absence of solid and widely approved diagnostic criteria for clinically significant hemolysis,render the utilization of hemolysis laboratory markers challenging.Hemolysis incidence varies(5%-18%)depending on definition and among different VAD generations,being slightly higher in continuous-flow devices than in pulsatile devices.Increased shear stress of red blood cells and underlying device thrombosis appear to be the main pathogenetic pathways.No certain algorithm is available for the management of hemolysis in patients with VADs,while close clinical and laboratory monitoring remains the cornerstone of management.Imaging examinations such as echocardiography ramp test or computed tomography scan could play a role in revealing the underlying cause.Treatment should be strictly personalized,including either pharmacological(antithrombotic treatment)or surgical interventions.展开更多
AIM To assess utility and correlation of known anticoagulation parameters in the management of pediatric ventricular assist device(VAD).METHODS Retrospective study of pediatric patients supported with a Berlin EXCOR V...AIM To assess utility and correlation of known anticoagulation parameters in the management of pediatric ventricular assist device(VAD).METHODS Retrospective study of pediatric patients supported with a Berlin EXCOR VAD at a single pediatric tertiary care center during a single year.RESULTS We demonstrated associations between activated thro-mboplastin time(a PTT)and R-thromboelastography(R-TEG)values(rs=0.65,P<0.001)and between anti-Xa assay and R-TEG values(rs=0.54,P<0.001).The strongest correlation was seen between a PTT and anti-Xa assays(rs=0.71,P<0.001).There was also a statistically significant correlation between platelet counts and the maximum amplitude of TEG(rs=0.71,P<0.001).Importantly,there was no association between dose of unfractionated heparin and either measure of anticoagulation(a PTT,anti-Xa or R-TEG value).CONCLUSION This study suggests that while there is strong correlation between a PTT,anti-Xa assay and R-TEG values for patients requiring VAD support,there is a lack of relevant correlation between heparin dose and degree of effect.This raises concern as various guidelines continue to recommend using these parameters to titrate heparin therapy.展开更多
Advanced heart failure has been traditionally treated via either heart transplantation,continuous inotropes,consideration for hospice and more recently via left ventricular assist devices(LVAD).Heart transplantation h...Advanced heart failure has been traditionally treated via either heart transplantation,continuous inotropes,consideration for hospice and more recently via left ventricular assist devices(LVAD).Heart transplantation has been limited by organ availability and the futility of other options has thrust LVAD therapy into the mainstream of therapy for end stage heart failure.Improvements in technology and survival combined with improvements in the quality of life have made LVADs a viable option for many patients suffering from heart failure.The question of when to implant these devices in those patients with advanced,yet still ambulatory heart failure remains a controversial topic.We discuss the current state of LVAD therapy and the risk vs benefit of these devices in the treatment of heart failure.展开更多
Context: Advanced heart failure (AHF) poses a global challenge, where heart transplantation is a treatment option but limited by donor scarcity. Proposal: This study aims to enhance the performance of ventricular assi...Context: Advanced heart failure (AHF) poses a global challenge, where heart transplantation is a treatment option but limited by donor scarcity. Proposal: This study aims to enhance the performance of ventricular assist devices (VADs) in the face of adverse events (AEs) using a resilience-based approach. The objective is to develop a method for integrating resilience attributes into VAD control systems, employing dynamic risk analysis and control strategies. Results: The outcomes include a resilient control architecture enabling anticipatory, regenerative, and degenerative actions in response to AEs. A method of applied resilience (MAR) based on dynamic risk management and resilience attribute analysis was proposed. Conclusion: Dynamic integration between medical and technical teams allows continuous adaptation of control systems to meet patient needs over time, improving reliability, safety, and effectiveness of VADs, with potential positive impact on the health of heart failure patients.展开更多
Background:A large gap exists between the needs of patients with end-stage heart failure and the number of gold-standard heart transplants.Over the past 30 years,a revolutionary treatment strategy using ventricular as...Background:A large gap exists between the needs of patients with end-stage heart failure and the number of gold-standard heart transplants.Over the past 30 years,a revolutionary treatment strategy using ventricular assist devices(VADs)has rapidly developed and become widely used in clinical practice.However,few analyses have assessed the application and publication trends in the VAD field.Method:We used the Web of Science core collection to identify VAD research published between 1992 and 2022.We performed analysis and data visualization with CiteSpace,Scimago Graphica,and VOSviewer.Results:We identified 13,274 articles published in 1129 journals,describing work from 6351 institutions in 86 countries.Among them,the United States contributed the most to VAD research,and almost all the top ten authors and institutions contributing to VAD research were from the United States.Conclusions:In the past 5 years,VAD research has focused on right heart failure,outcomes,effects and risk factors,societies of surgeons,and clinical guidelines.Because of the large number of patients with heart failure,we expect VAD development to peak in the next decade.展开更多
Two applications of the hybrid simulators have been presented as examples: nonpulsatile VAD interaction with lumped parameters cardiovascular system numerical model and respirator interacting with the Dubois numerical...Two applications of the hybrid simulators have been presented as examples: nonpulsatile VAD interaction with lumped parameters cardiovascular system numerical model and respirator interacting with the Dubois numerical model of obstructive lung diseases. The results of simulations showed how the tested assist devices change biological system - assist device characteristics in the course of heart or lungs diseases and how it influences pressure and flow in a particular point of cardiovascular or respiratory system numerical model.展开更多
Objectives To evaluate retrospectively the potential benefits of combined utilization of various assisted circulation devices in cardiac arrest patients who did not respond to conventional cardiopulmonary cerebral res...Objectives To evaluate retrospectively the potential benefits of combined utilization of various assisted circulation devices in cardiac arrest patients who did not respond to conventional cardiopulmonary cerebral resuscitation （CPCR）. Methods Assisted circulation devices, including emergency cardiopulmonary bypass （ECPB）, intra-aortic balloon pump （IABP）, and left ventricular assist device （LVAD）, were applied to 16 adult patients who had cardiac arrest 82 rain-56 h after open heart surgery and did not respond to 20 rain or longer conventional CPCR. ECPB was applied to 2 patients, ECPB plus IABP to 8 patients, ECPB plus IABP and LVAD to 6 patients. Results One patient recovered fully and one patient died. Of the other 14 patients, 13 resumed spontaneous cardiac rhythm and one did not; none of them could be weaned from ECPB. Further treatment of the 14 patients with combinations of assisted circulation devices enabled 6 patients to recover. One of the 7 recovered patients died of reoccurring cardiac arrest after 11 days; the other 6 were discharged in good condition and were followed up for 3-49 months （mean =22 months）. Of the 6 discharged patients one suffered cerebral embolism during LVAD treatment, resulting in mild limitation of mobility of the right limbs ; the other 5 never manifested any central nervous system complications. There was no late deaths giving a 37.5% （6/16） long-term survival rate. Conclusions ECPB could effectively reestablish blood circulation and oxygen supply, rectify acidosis, and improve internal milieu. The combined utilization of ECPB, IABP, and LVAD reduces the duration of ECPB, improves the incidence of recovery, and offers beneficial alternatives to refractory cardiac arrest patients.展开更多
Left ventricular assist devices (LVADs) represent a cornerstone therapy foradvanced heart failure. However, their efficacy in patients with type 2 diabetesmellitus (T2DM) is challenged by diabetes-exacerbated complica...Left ventricular assist devices (LVADs) represent a cornerstone therapy foradvanced heart failure. However, their efficacy in patients with type 2 diabetesmellitus (T2DM) is challenged by diabetes-exacerbated complications. To determineoptimal pharmacological strategies to mitigate major LVAD-relatedcomplications in patients with T2DM. This review provides evidence for pharmacologicalstrategies to mitigate major LVAD-related complications in T2DM, inwhich endothelial dysfunction (via impaired PI3K/Akt-NO signaling), chronicinflammation, and diabetic nephropathy amplify the risk of thrombosis, bleeding,infection, and right ventricular (RV) failure. For thromboembolism prevention,individualized warfarin management (international normalized ratio: 2.0-3.0)with intensified monitoring is essential, while aspirin omission in magneticallylevitated devices (2 trials) reduces bleeding. Phosphodiesterase-5 inhibitors showpromise for thrombosis reduction, but require bleeding risk assessment. Glycemiccontrol necessitates the proactive de-escalation of insulin/sulfonylureas post-LVAD owing to improved insulin sensitivity and hypoglycemia risks, favoringSGLT-2 inhibitors/GLP-1 receptor agonists for cardiometabolic benefits. Drivelineinfection management requires renal-adjusted antimicrobial prophylaxis, culturedirectedtherapy, and novel approaches for drug-resistant cases. The preventionof RV failure depends on preoperative hemodynamic optimization and postoperativeinotropic support. A multidisciplinary approach integrating anticoagulationprecision, infection control, glycemic tailoring, and hemodynamic stabilizationis critical to counter T2DM-pathophysiology interactions.展开更多
Temporary mechanical circulatory support (tMCS) devices such as intra-aorticballoon pumps, veno-arterial extracorporeal membrane oxygenation, and percutaneousventricular assist devices, play a major role in supporting...Temporary mechanical circulatory support (tMCS) devices such as intra-aorticballoon pumps, veno-arterial extracorporeal membrane oxygenation, and percutaneousventricular assist devices, play a major role in supporting patients withend-stage heart failure and bridging them to transplant. In 2018, the United Networkfor Organ Sharing heart allocation criteria was modified by increasing thenumber of statuses in the heart transplant waitlist to differentiate and favor thesickest patients awaiting transplantation. Within this new system, patients withtMCS devices receive the highest priority statuses. While the 2018 allocationsystem has reduced waitlist times and mortality for the highest-priority patients,some studies have shown a concomitant rise in the utilization of tMCS devices asbridge to transplant after its enaction. In this narrative review, we describe thesechanges in tMCS utilization and provide insights on how the upcoming creationof a continuous distribution allocation system may further impact these trends.展开更多
BACKGROUND Development of pericardial effusion in patients with left ventricular assist devices(LVADs)can be detrimental to health outcomes.This study aims to elucidate the prevalence and risk factors for pericardial ...BACKGROUND Development of pericardial effusion in patients with left ventricular assist devices(LVADs)can be detrimental to health outcomes.This study aims to elucidate the prevalence and risk factors for pericardial effusion in patients with LVADs.AIM To elucidate risk factors associated with the presence of pericardial effusion in patients with LVADs and compare the clinical outcomes of those with and without pericardial effusion.The secondary goal is to determine the incidence of pericardiocentesis and pericardial window placement in patients with LVADs experiencing pericardial effusion.METHODS Data were obtained from the National Inpatient Sample database between 2016 and 2018.Statistical analysis was performed using Pearsonχ2 test and multivariate logistic regression analysis to determine clinical outcomes of pericardial effusion and to identify variables associated with pericardial effusion in LVAD patients,respectively.RESULTS The prevalence of LVAD was 9850(0.01%)among total study patients(n=98112095).The incidence of pericardial effusion among LVAD patients was 640(6.5%).The prevalence of liver disease(26.6%vs 17.4%),chronic kidney disease(CKD;54.6%vs 49.4%),hypothyroidism(21.9%vs 18.1%),congestive heart failure(98.4%vs 96.5%),atrial fibrillation(Afib;58.59%vs 50.5%),coronary artery disease(CAD;11.7%vs 4.4%),dyslipidemia(31.3%vs 39.3%),and having undergone percutaneous coronary intervention(PCI;1.6%vs 0.7%)was higher in the pericardial effusion cohort vs the non-pericardial effusion cohort.Multivariate regression analysis demonstrated that CAD(OR=2.89)and PCI(OR=2.2)had the greatest association with pericardial effusion in patients with LVADs.These were followed by liver disease(OR=1.72),hypothyroidism(OR=1.2),electrolyte derangement(OR=1.2),Afib(OR=1.1),and CKD(OR=1.05).Among patients with LVADs,the median length of stay(33 days vs 27 days)and hospitalization cost(847525 USD vs 792616 USD)were significantly higher in the pericardial effusion cohort compared to the non-pericardial effusion cohort.There was no significant difference in mortality between cohorts.The prevalence of cardiac tamponade was 109(17.9%of LVAD patients with pericardial effusion).Ten(9.2%of LVAD patients with cardiac tamponade)patients underwent pericardiocentesis and 44(40.3%)received a pericardial window.CONCLUSION This study shows that liver disease,CKD,PCI,hypothyroidism,electrolyte derangement,Afib,and CAD had a significant association with pericardial effusion in LVAD patients.Hospitalization cost and length of stay were higher in the pericardial effusion group,but mortality was the same.展开更多
文摘This study aimed to comprehensively investigate the essential considerations in designing adaptive clothing for women with lower limb prostheses in Saudi Arabia. Employing a qualitative methodology, the research entailed semi-structured, in-depth interviews with women utilizing lower limb prostheses and prosthetic specialists. This approach was selected to unearth pivotal design prerequisites and comprehend the specific challenges these women encounter within the realm of clothing. The utilization of selective sampling facilitated the collection of intricate and valuable insights. A Functional, Expressive, and Aesthetic (FEA) User Needs model was utilized to scrutinize participant feedback. Functional requisites encompass ease of dressing and undressing, accessibility to the prosthetic limb, comfort, mobility with the prosthesis, and appropriate fit. Additionally, participants highlighted various expressive needs, including privacy preservation, modesty, camouflaging disability appearances, maintaining alignment with non-disabled women’s fashion, and considerations about the aesthetic aspects of garments.
基金supported by the National Natural Science Foundation of China(nos.32360196,and 32160204)the Key R&D Project of Hainan Province(grant nos.ZDYF2022SHFZ302 and ZDYF2022SHFZ275)+6 种基金the Major Science and Technology Projects of Hainan Province(grant no.ZDKJ2021032)Hainan Province Clinical Medical Center(no.0202067)Science,Technology,and Innovation Commission of Shenzhen Municipality(STICproject no.SGDX20220530111005036)Basic and Applied Basic Research Fund of Guangdong Province:Regional Joint Fund Project Youth Fund(project no.2021A1515110356)Shenzhen Science and Technology Plan Project(project no.JCYJ20220818101407016)by the Project of Sanya Yazhou Bay Science and Technology City(no.SCKJJYRC-2023-27).
文摘The concept of gait synergy provides novel human-machine interfaces and has been applied to the control of lower limb assistive devices,such as powered prostheses and exoskeletons.Specifically,on the basis of gait synergy,the assistive device can generate/predict the appropriate reference trajectories precisely for the affected or missing parts from the motions of sound parts of the patients.Optimal modeling for gait synergy methods that involves optimal combinations of features(inputs)is required to achieve synergic trajectories that improve human–machine interaction.However,previous studies lack thorough discussions on the optimal methods for synergy modeling.In addition,feature selection(FS)that is crucial for reducing data dimensionality and improving modeling quality has often been neglected in previous studies.Here,we comprehensively investigated modeling methods and FS using 4 up-to-date neural networks:sequence-to-sequence(Seq2Seq),long short-term memory(LSTM),recurrent neural network(RNN),and gated recurrent unit(GRU).We also conducted complete FS using 3 commonly used methods:random forest,information gain,and Pearson correlation.Our findings reveal that Seq2Seq(mean absolute error:0.404°and 0.596°,respectively)outperforms LSTM,RNN,and GRU for both interlimb and intralimb synergy modeling.Furthermore,FS is proven to significantly improve Seq2Seq’s modeling performance(P<0.05).FS-Seq2Seq even outperforms methods used in existing studies.Therefore,we propose FSSeq2Seq as a 2-stage strategy for gait synergy modeling in lower limb assistive devices with the aim of achieving synergic and user-adaptive trajectories that improve human-machine interactions.
文摘While biventricular assist devices(BiVADs)remain underutilized in Western countries for biventricular heart failure(BHF),their application is expanding in China.This consensus synthesizes international guidelines,medical evidence,and Chinese clinical expertise to establish standardized protocols for BiVAD management.Key recommendations include:(1)Preoperative right heart catheterization and echocardiography for central venous pressure(CVP):pulmonary capillary wedge pressure(PCWP)ratio and pulmonary artery pulsatility index(PAPi)assessment(Class I);(2)BiVAD indication in refractory BHF or high-risk right heart failure post-left ventricular assist device(LVAD)implantation(Class IIa);(3)Right atrial implantation as the preferred surgical approach(Class IIa);(4)Warfarin-based anticoagulation(INR 2.0–2.5)with aspirin,avoiding direct oral anticoagulants(DOACs)(Class III).The guidance addresses critical gaps in patient selection,pump speed titration,and complication management,positioning integrated BiVAD systems as a promising solution for complex BHF.
基金Project supported by the National Natural Science Foundation of China(No.50821003)the Shanghai Committee of Science and Technology(No.15441905200),China
文摘Heart failure has become one of the biggest threats to human health. Transplantation remains the most effective therapy for heart failure, but because of the shortage of donors, it cannot meet the demand. Ventricular assist devices （VADs） were developed to treat heart failure, and have now been clinically applied worldwide. As the country with the largest population, China is also facing the threat of heart failure. However, the development of VADs in China is very slow and is seldom discussed. This paper first talks about the background for VAD development in China. Then several home-developed VADs in China are introduced. The current clinical application status of VADs in China is also presented. Finally the challenge and opportunity for VAD development in China are discussed.
文摘Left ventricular assist devices(LVAD)are increasingly become common as life prolonging therapy in patients with advanced heart failure.Current devices are now used as definitive treatment in some patients given the improved durability of continuous flow pumps.Unfortunately,continuous flow LVADs are fraught with complications such as gastrointestinal(GI)bleeding that are primarily attributed to the formation of arteriovenous malformations.With frequent GI bleeding,antiplatelet and anticoagulation therapies are usually discontinued increasing the risk of life-threatening events.Small bowel bleeds account for 15%as the source and patients often undergo multiple endoscopic procedures.Treatment strategies include resuscitative measures and endoscopic therapies.Medical treatment is with octreotide.Novel treatment options include thalidomide,angiotensin converting enzyme inhibitors/angiotensinⅡreceptor blockers,estrogen-based hormonal therapies,doxycycline,desmopressin and bevacizumab.Current research has explored the mechanism of frequent GI bleeds in this population,including destruction of von Willebrand factor,upregulation of tissue factor,vascular endothelial growth factor,tumor necrosis factor-α,tumor growth factor-β,and angiopoetin-2,and downregulation of angiopoetin-1.In addition,healthcare resource utilization is only increasing in this patient population with higher admissions,readmissions,blood product utilization,and endoscopy.While some of the novel endoscopic and medical therapies for LVAD bleeds are still in their development stages,these tools will yet be crucial as the number of LVAD placements will likely only increase in the coming years.
文摘As cardiac implantable electronic devices(CIED)become more prevalent,it is important to acknowledge potential electromagnetic interference(EMI)from other sources,such as internal and external electronic devices and procedures and its effect on these devices.EMI from other sources can potentially inhibit pacing and trigger shocks in permanent pacemakers(PPM)and implantable cardioverter defibrillators(ICD),respectively.This review analyzes potential EMI amongst CIED and left ventricular assist device,deep brain stimulators,spinal cord stimulators,transcutaneous electrical nerve stimulators,and throughout an array of procedures,such as endoscopy,bronchoscopy,and procedures involving electrocautery.Although there is evidence to support EMI from internal and external devices and during procedures,there is a lack of large multicenter studies,and,as a result,current management guidelines are based primarily on expert opinion and anecdotal experience.We aim to provide a general overview of PPM/ICD function,review documented EMI effect on these devices,and acknowledge current management of CIED interference.
文摘Ventricular assist devices(VADs)have played an important role in altering the natural history of end-stage heart failure.Low-grade hemolysis has been traditionally described in patients with VADs,indicating effective device functionality.However,clinically significant hemolysis could be crucial in terms of prognosis,calling for prompt therapeutic actions.The absence of solid and widely approved diagnostic criteria for clinically significant hemolysis,render the utilization of hemolysis laboratory markers challenging.Hemolysis incidence varies(5%-18%)depending on definition and among different VAD generations,being slightly higher in continuous-flow devices than in pulsatile devices.Increased shear stress of red blood cells and underlying device thrombosis appear to be the main pathogenetic pathways.No certain algorithm is available for the management of hemolysis in patients with VADs,while close clinical and laboratory monitoring remains the cornerstone of management.Imaging examinations such as echocardiography ramp test or computed tomography scan could play a role in revealing the underlying cause.Treatment should be strictly personalized,including either pharmacological(antithrombotic treatment)or surgical interventions.
文摘AIM To assess utility and correlation of known anticoagulation parameters in the management of pediatric ventricular assist device(VAD).METHODS Retrospective study of pediatric patients supported with a Berlin EXCOR VAD at a single pediatric tertiary care center during a single year.RESULTS We demonstrated associations between activated thro-mboplastin time(a PTT)and R-thromboelastography(R-TEG)values(rs=0.65,P<0.001)and between anti-Xa assay and R-TEG values(rs=0.54,P<0.001).The strongest correlation was seen between a PTT and anti-Xa assays(rs=0.71,P<0.001).There was also a statistically significant correlation between platelet counts and the maximum amplitude of TEG(rs=0.71,P<0.001).Importantly,there was no association between dose of unfractionated heparin and either measure of anticoagulation(a PTT,anti-Xa or R-TEG value).CONCLUSION This study suggests that while there is strong correlation between a PTT,anti-Xa assay and R-TEG values for patients requiring VAD support,there is a lack of relevant correlation between heparin dose and degree of effect.This raises concern as various guidelines continue to recommend using these parameters to titrate heparin therapy.
文摘Advanced heart failure has been traditionally treated via either heart transplantation,continuous inotropes,consideration for hospice and more recently via left ventricular assist devices(LVAD).Heart transplantation has been limited by organ availability and the futility of other options has thrust LVAD therapy into the mainstream of therapy for end stage heart failure.Improvements in technology and survival combined with improvements in the quality of life have made LVADs a viable option for many patients suffering from heart failure.The question of when to implant these devices in those patients with advanced,yet still ambulatory heart failure remains a controversial topic.We discuss the current state of LVAD therapy and the risk vs benefit of these devices in the treatment of heart failure.
文摘Context: Advanced heart failure (AHF) poses a global challenge, where heart transplantation is a treatment option but limited by donor scarcity. Proposal: This study aims to enhance the performance of ventricular assist devices (VADs) in the face of adverse events (AEs) using a resilience-based approach. The objective is to develop a method for integrating resilience attributes into VAD control systems, employing dynamic risk analysis and control strategies. Results: The outcomes include a resilient control architecture enabling anticipatory, regenerative, and degenerative actions in response to AEs. A method of applied resilience (MAR) based on dynamic risk management and resilience attribute analysis was proposed. Conclusion: Dynamic integration between medical and technical teams allows continuous adaptation of control systems to meet patient needs over time, improving reliability, safety, and effectiveness of VADs, with potential positive impact on the health of heart failure patients.
文摘Background:A large gap exists between the needs of patients with end-stage heart failure and the number of gold-standard heart transplants.Over the past 30 years,a revolutionary treatment strategy using ventricular assist devices(VADs)has rapidly developed and become widely used in clinical practice.However,few analyses have assessed the application and publication trends in the VAD field.Method:We used the Web of Science core collection to identify VAD research published between 1992 and 2022.We performed analysis and data visualization with CiteSpace,Scimago Graphica,and VOSviewer.Results:We identified 13,274 articles published in 1129 journals,describing work from 6351 institutions in 86 countries.Among them,the United States contributed the most to VAD research,and almost all the top ten authors and institutions contributing to VAD research were from the United States.Conclusions:In the past 5 years,VAD research has focused on right heart failure,outcomes,effects and risk factors,societies of surgeons,and clinical guidelines.Because of the large number of patients with heart failure,we expect VAD development to peak in the next decade.
文摘Two applications of the hybrid simulators have been presented as examples: nonpulsatile VAD interaction with lumped parameters cardiovascular system numerical model and respirator interacting with the Dubois numerical model of obstructive lung diseases. The results of simulations showed how the tested assist devices change biological system - assist device characteristics in the course of heart or lungs diseases and how it influences pressure and flow in a particular point of cardiovascular or respiratory system numerical model.
文摘Objectives To evaluate retrospectively the potential benefits of combined utilization of various assisted circulation devices in cardiac arrest patients who did not respond to conventional cardiopulmonary cerebral resuscitation （CPCR）. Methods Assisted circulation devices, including emergency cardiopulmonary bypass （ECPB）, intra-aortic balloon pump （IABP）, and left ventricular assist device （LVAD）, were applied to 16 adult patients who had cardiac arrest 82 rain-56 h after open heart surgery and did not respond to 20 rain or longer conventional CPCR. ECPB was applied to 2 patients, ECPB plus IABP to 8 patients, ECPB plus IABP and LVAD to 6 patients. Results One patient recovered fully and one patient died. Of the other 14 patients, 13 resumed spontaneous cardiac rhythm and one did not; none of them could be weaned from ECPB. Further treatment of the 14 patients with combinations of assisted circulation devices enabled 6 patients to recover. One of the 7 recovered patients died of reoccurring cardiac arrest after 11 days; the other 6 were discharged in good condition and were followed up for 3-49 months （mean =22 months）. Of the 6 discharged patients one suffered cerebral embolism during LVAD treatment, resulting in mild limitation of mobility of the right limbs ; the other 5 never manifested any central nervous system complications. There was no late deaths giving a 37.5% （6/16） long-term survival rate. Conclusions ECPB could effectively reestablish blood circulation and oxygen supply, rectify acidosis, and improve internal milieu. The combined utilization of ECPB, IABP, and LVAD reduces the duration of ECPB, improves the incidence of recovery, and offers beneficial alternatives to refractory cardiac arrest patients.
文摘Left ventricular assist devices (LVADs) represent a cornerstone therapy foradvanced heart failure. However, their efficacy in patients with type 2 diabetesmellitus (T2DM) is challenged by diabetes-exacerbated complications. To determineoptimal pharmacological strategies to mitigate major LVAD-relatedcomplications in patients with T2DM. This review provides evidence for pharmacologicalstrategies to mitigate major LVAD-related complications in T2DM, inwhich endothelial dysfunction (via impaired PI3K/Akt-NO signaling), chronicinflammation, and diabetic nephropathy amplify the risk of thrombosis, bleeding,infection, and right ventricular (RV) failure. For thromboembolism prevention,individualized warfarin management (international normalized ratio: 2.0-3.0)with intensified monitoring is essential, while aspirin omission in magneticallylevitated devices (2 trials) reduces bleeding. Phosphodiesterase-5 inhibitors showpromise for thrombosis reduction, but require bleeding risk assessment. Glycemiccontrol necessitates the proactive de-escalation of insulin/sulfonylureas post-LVAD owing to improved insulin sensitivity and hypoglycemia risks, favoringSGLT-2 inhibitors/GLP-1 receptor agonists for cardiometabolic benefits. Drivelineinfection management requires renal-adjusted antimicrobial prophylaxis, culturedirectedtherapy, and novel approaches for drug-resistant cases. The preventionof RV failure depends on preoperative hemodynamic optimization and postoperativeinotropic support. A multidisciplinary approach integrating anticoagulationprecision, infection control, glycemic tailoring, and hemodynamic stabilizationis critical to counter T2DM-pathophysiology interactions.
文摘Temporary mechanical circulatory support (tMCS) devices such as intra-aorticballoon pumps, veno-arterial extracorporeal membrane oxygenation, and percutaneousventricular assist devices, play a major role in supporting patients withend-stage heart failure and bridging them to transplant. In 2018, the United Networkfor Organ Sharing heart allocation criteria was modified by increasing thenumber of statuses in the heart transplant waitlist to differentiate and favor thesickest patients awaiting transplantation. Within this new system, patients withtMCS devices receive the highest priority statuses. While the 2018 allocationsystem has reduced waitlist times and mortality for the highest-priority patients,some studies have shown a concomitant rise in the utilization of tMCS devices asbridge to transplant after its enaction. In this narrative review, we describe thesechanges in tMCS utilization and provide insights on how the upcoming creationof a continuous distribution allocation system may further impact these trends.
文摘BACKGROUND Development of pericardial effusion in patients with left ventricular assist devices(LVADs)can be detrimental to health outcomes.This study aims to elucidate the prevalence and risk factors for pericardial effusion in patients with LVADs.AIM To elucidate risk factors associated with the presence of pericardial effusion in patients with LVADs and compare the clinical outcomes of those with and without pericardial effusion.The secondary goal is to determine the incidence of pericardiocentesis and pericardial window placement in patients with LVADs experiencing pericardial effusion.METHODS Data were obtained from the National Inpatient Sample database between 2016 and 2018.Statistical analysis was performed using Pearsonχ2 test and multivariate logistic regression analysis to determine clinical outcomes of pericardial effusion and to identify variables associated with pericardial effusion in LVAD patients,respectively.RESULTS The prevalence of LVAD was 9850(0.01%)among total study patients(n=98112095).The incidence of pericardial effusion among LVAD patients was 640(6.5%).The prevalence of liver disease(26.6%vs 17.4%),chronic kidney disease(CKD;54.6%vs 49.4%),hypothyroidism(21.9%vs 18.1%),congestive heart failure(98.4%vs 96.5%),atrial fibrillation(Afib;58.59%vs 50.5%),coronary artery disease(CAD;11.7%vs 4.4%),dyslipidemia(31.3%vs 39.3%),and having undergone percutaneous coronary intervention(PCI;1.6%vs 0.7%)was higher in the pericardial effusion cohort vs the non-pericardial effusion cohort.Multivariate regression analysis demonstrated that CAD(OR=2.89)and PCI(OR=2.2)had the greatest association with pericardial effusion in patients with LVADs.These were followed by liver disease(OR=1.72),hypothyroidism(OR=1.2),electrolyte derangement(OR=1.2),Afib(OR=1.1),and CKD(OR=1.05).Among patients with LVADs,the median length of stay(33 days vs 27 days)and hospitalization cost(847525 USD vs 792616 USD)were significantly higher in the pericardial effusion cohort compared to the non-pericardial effusion cohort.There was no significant difference in mortality between cohorts.The prevalence of cardiac tamponade was 109(17.9%of LVAD patients with pericardial effusion).Ten(9.2%of LVAD patients with cardiac tamponade)patients underwent pericardiocentesis and 44(40.3%)received a pericardial window.CONCLUSION This study shows that liver disease,CKD,PCI,hypothyroidism,electrolyte derangement,Afib,and CAD had a significant association with pericardial effusion in LVAD patients.Hospitalization cost and length of stay were higher in the pericardial effusion group,but mortality was the same.
