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264: The Association between Body Mass Index and Drive-Line Infections after Left Ventricular Assist Device Implantation
The Journal of Heart and Lung Transplantation Volume 27, Number 2S
brane oxygenation in 11 cases (78.5%), with peripheral cannulation in five cases. Results: Mean support time was 12 days (range 3-30) for all patients. In group A, three patients (60%) has been transplanted and discharged home; one has been bridged to implantable long-term ventricular assist device, but he died because of multiorgan failure; the remaining one died on ECMO because of multiorgan failure. In group B, four patients (44.4%) has been successfully weaned from Levitronix; two patients with myocarditis has been discharged home. We did not observe any device failure or device-related complications. Conclusions: Our experience suggests that early implantation of the Levitronix in patients hemodynamically unstable with cardiogenic shock may provide effective, reliable, relatively low-coast, safe and versatile short-term circulatory support. Offering a valuable therapeutic option to a group of patients to wait recovery or that otherwise are poor candidates for immediate permanent device placement or heart transplantation.
262 BIVACOR Rotary Bi-Ventricular Assist Device Evaluation Using Epicardial and Intracardiac Echocardiography – Initial Animal In Vivo Experience D.G. Platts,1 D. Timms,1 J. Fraser,1 K. McNeil,1 B. Thompson,1 K. Wilson,2 K. Dunster,2 D. Burstow,1 1Heart Failure and Transplant Unit, The Prince Charles Hospital, Brisbane, Queensland, Australia; 2School of Medicine, University of Queensland, Brisbane, QLD, Australia Purpose: The BIVACOR rotary pump is a novel BiVAD/TAH designed to support the haemodynamics of systemic and pulmonary circulatory systems. The centrifugal pump has left and right vanes positioned on a common rotating double sided impeller. This study assessed the feasibility of utilising epicardial echocardiography (EPE) and intracardiac echocardiography (ICE) in aiding device management and detection of complications during pump evaluation in 5 sheep. Methods and Materials: 5 acute, non recovery sheep animal models were evaluated with EPE and ICE. EPE was performed using an S12 transducer and a Philips SONOS 5500 machine. ICE was performed via cannulation of a pulmonary vein (cases 1,2) or a jugular vein sheath (cases 3-5) with a 10F(cases 1-3) or 8F(case 4,5) ICE catheter and Siemens Sequoia machine. Imaging was performed after device insertion and commencement of normal function. Both imaging types evaluated cardiac chamber sizes, cannulae positioning and flow (colour and continuous wave Doppler) and any associated complications. Results: Left sided approach ICE resulted in clear evaluation of the LA, LV and LV inflow cannulae position. Right sided ICE provided clear evaluation of the RA, RV and RA inflow cannulae position. ICE provided superior imaging internally within the RA inflow cannula. ICE detected a RA and RAA thrombus, which extended down the RA inflow cannula. Local thrombolysis under ICE guidance was utilised (case 3). ICE also detected a SVC thrombus (case 5). EPE provided clear evaluation of all 4 cardiac chambers (especially volume status), aortic and pulmonary valve function and guided in LV inflow cannulae repositioning (case 4). EPE detected a LV thrombus (case 1) and LA thrombus (case 4). Conclusions: The results from the EPE and ICE images indicate that both forms of imaging are feasible in evaluating BIVACOR cannulae placement, cannulae function and associated complications, along with assessing native heart anatomy and function. Jugular approach ICE holds promise in future closed chest models.
Abstracts
S155
263 VentAssist Left Ventricular Assist Device: St Vincent’s Hospital Experience I.M. Ahmed,1 P.M. Spratt,1 P. Jansz,1 C. Axisa,1 P. MacDonald,1 E. Granger,1 1Department of Cardiothoracic Surgery and Transplantation, St Vincents Hospital, Sydney, NSW, Australia Purpose: The use of ventricular assist devices (VAD) has become a widely accepted therapeutic option as a bridge to heart transplant or destination therapy. We present our experience to date for the VentrAssist device, a third generation centrifugal VAD, in 22 patients. Methods and Materials: A total of 22 devices have been implanted between June 2003 and September 2007, 16 as bridge to transplant and 6 as destination therapy. All patients were in persistent cardiogenic shock despite maximum inotropic support and had numerous preoperative risk factors including intra-aortic balloon pump, acute renal failure and previous cardiac surgery. Results: Mean duration of support for bridge to transplant was 419 days (range 21-743 days) and for destination therapy was 331 days (range 108-619 days). 1 patient died in the destination group after 619 days with multi organ failure and 2 patients died in the bridge to transplant group (cerebral haemorrhage and multi-organ failure). There were no mechanical device failures. Currently 5 patients have been successfully transplanted. There were significant improvements in Cardiac Index and Quality of Life scores (p⬍0.05) in both groups. Conclusions: Efficacy and safety data from using the VentrAssist device were favourable. Survival rates for the VentrAssist were higher than that reported for other left ventricular devices.
264 The Association between Body Mass Index and Drive-Line Infections after Left Ventricular Assist Device Implantation C.A. Wood,1 M.D. Thomas,1 G. O’Driscoll,1,2 1Advanced Heart Failure & Cardiac Transplant Service, Royal Perth Hospital, Perth, Western Australia, Australia; 2School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia Purpose: Malnutrition and nutritional status have been previously documented as significant contributors to the number of adverse post operative outcomes in patients requiring Left Ventricular Assist Device (LVAD) therapy. This study sought to assesses the effect of Body Mass Index (BMI) on the prevalence of drive-line infections after LVAD implantation. Methods and Materials: Between August 2000 and July 2007, 37 patients underwent LVAD implantation (35 males, 2 females, mean age, 44 years) as a bridge to transplant (33 patients) or as destination therapy (4 patients). They were supported by a variety of devices, Heartmate XVE™ (n⫽13), VentrAssist™ (n⫽10), Jarvik 2000® (n⫽10) and HVAD™ (n⫽ 4). Body mass index (BMI) was recorded directly prior to surgery, retrospective analysis of data compared patients for prevalence of drive-line infection after LVAD implantation. Results: Obesity, as defined by a BMI greater than 25, was evident in 51% (19) patients. There was a significant increase in the prevalence of drive-line infections in those patients with a BMI ⱖ 25 compared with those with a BMI ⬍ 25; 74% vs 39%, p⬍0.05. Conclusions: Among patients with implantable LVADs, a ⱖ 25 BMI is associated with an increased prevalence of drive-line infection. Careful risk stratification and comprehensive evaluation by health care providers should be performed for all potential LVAD recipients. Provision of nutritional rehabilitation pre and post LVAD implant should be encouraged to enhance patient outcomes.
brane oxygenation in 11 cases (78.5%), with peripheral cannulation in five cases. Results: Mean support time was 12 days (range 3-30) for all patients. In group A, three patients (60%) has been transplanted and discharged home; one has been bridged to implantable long-term ventricular assist device, but he died because of multiorgan failure; the remaining one died on ECMO because of multiorgan failure. In group B, four patients (44.4%) has been successfully weaned from Levitronix; two patients with myocarditis has been discharged home. We did not observe any device failure or device-related complications. Conclusions: Our experience suggests that early implantation of the Levitronix in patients hemodynamically unstable with cardiogenic shock may provide effective, reliable, relatively low-coast, safe and versatile short-term circulatory support. Offering a valuable therapeutic option to a group of patients to wait recovery or that otherwise are poor candidates for immediate permanent device placement or heart transplantation.
262 BIVACOR Rotary Bi-Ventricular Assist Device Evaluation Using Epicardial and Intracardiac Echocardiography – Initial Animal In Vivo Experience D.G. Platts,1 D. Timms,1 J. Fraser,1 K. McNeil,1 B. Thompson,1 K. Wilson,2 K. Dunster,2 D. Burstow,1 1Heart Failure and Transplant Unit, The Prince Charles Hospital, Brisbane, Queensland, Australia; 2School of Medicine, University of Queensland, Brisbane, QLD, Australia Purpose: The BIVACOR rotary pump is a novel BiVAD/TAH designed to support the haemodynamics of systemic and pulmonary circulatory systems. The centrifugal pump has left and right vanes positioned on a common rotating double sided impeller. This study assessed the feasibility of utilising epicardial echocardiography (EPE) and intracardiac echocardiography (ICE) in aiding device management and detection of complications during pump evaluation in 5 sheep. Methods and Materials: 5 acute, non recovery sheep animal models were evaluated with EPE and ICE. EPE was performed using an S12 transducer and a Philips SONOS 5500 machine. ICE was performed via cannulation of a pulmonary vein (cases 1,2) or a jugular vein sheath (cases 3-5) with a 10F(cases 1-3) or 8F(case 4,5) ICE catheter and Siemens Sequoia machine. Imaging was performed after device insertion and commencement of normal function. Both imaging types evaluated cardiac chamber sizes, cannulae positioning and flow (colour and continuous wave Doppler) and any associated complications. Results: Left sided approach ICE resulted in clear evaluation of the LA, LV and LV inflow cannulae position. Right sided ICE provided clear evaluation of the RA, RV and RA inflow cannulae position. ICE provided superior imaging internally within the RA inflow cannula. ICE detected a RA and RAA thrombus, which extended down the RA inflow cannula. Local thrombolysis under ICE guidance was utilised (case 3). ICE also detected a SVC thrombus (case 5). EPE provided clear evaluation of all 4 cardiac chambers (especially volume status), aortic and pulmonary valve function and guided in LV inflow cannulae repositioning (case 4). EPE detected a LV thrombus (case 1) and LA thrombus (case 4). Conclusions: The results from the EPE and ICE images indicate that both forms of imaging are feasible in evaluating BIVACOR cannulae placement, cannulae function and associated complications, along with assessing native heart anatomy and function. Jugular approach ICE holds promise in future closed chest models.
Abstracts
S155
263 VentAssist Left Ventricular Assist Device: St Vincent’s Hospital Experience I.M. Ahmed,1 P.M. Spratt,1 P. Jansz,1 C. Axisa,1 P. MacDonald,1 E. Granger,1 1Department of Cardiothoracic Surgery and Transplantation, St Vincents Hospital, Sydney, NSW, Australia Purpose: The use of ventricular assist devices (VAD) has become a widely accepted therapeutic option as a bridge to heart transplant or destination therapy. We present our experience to date for the VentrAssist device, a third generation centrifugal VAD, in 22 patients. Methods and Materials: A total of 22 devices have been implanted between June 2003 and September 2007, 16 as bridge to transplant and 6 as destination therapy. All patients were in persistent cardiogenic shock despite maximum inotropic support and had numerous preoperative risk factors including intra-aortic balloon pump, acute renal failure and previous cardiac surgery. Results: Mean duration of support for bridge to transplant was 419 days (range 21-743 days) and for destination therapy was 331 days (range 108-619 days). 1 patient died in the destination group after 619 days with multi organ failure and 2 patients died in the bridge to transplant group (cerebral haemorrhage and multi-organ failure). There were no mechanical device failures. Currently 5 patients have been successfully transplanted. There were significant improvements in Cardiac Index and Quality of Life scores (p⬍0.05) in both groups. Conclusions: Efficacy and safety data from using the VentrAssist device were favourable. Survival rates for the VentrAssist were higher than that reported for other left ventricular devices.
264 The Association between Body Mass Index and Drive-Line Infections after Left Ventricular Assist Device Implantation C.A. Wood,1 M.D. Thomas,1 G. O’Driscoll,1,2 1Advanced Heart Failure & Cardiac Transplant Service, Royal Perth Hospital, Perth, Western Australia, Australia; 2School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia Purpose: Malnutrition and nutritional status have been previously documented as significant contributors to the number of adverse post operative outcomes in patients requiring Left Ventricular Assist Device (LVAD) therapy. This study sought to assesses the effect of Body Mass Index (BMI) on the prevalence of drive-line infections after LVAD implantation. Methods and Materials: Between August 2000 and July 2007, 37 patients underwent LVAD implantation (35 males, 2 females, mean age, 44 years) as a bridge to transplant (33 patients) or as destination therapy (4 patients). They were supported by a variety of devices, Heartmate XVE™ (n⫽13), VentrAssist™ (n⫽10), Jarvik 2000® (n⫽10) and HVAD™ (n⫽ 4). Body mass index (BMI) was recorded directly prior to surgery, retrospective analysis of data compared patients for prevalence of drive-line infection after LVAD implantation. Results: Obesity, as defined by a BMI greater than 25, was evident in 51% (19) patients. There was a significant increase in the prevalence of drive-line infections in those patients with a BMI ⱖ 25 compared with those with a BMI ⬍ 25; 74% vs 39%, p⬍0.05. Conclusions: Among patients with implantable LVADs, a ⱖ 25 BMI is associated with an increased prevalence of drive-line infection. Careful risk stratification and comprehensive evaluation by health care providers should be performed for all potential LVAD recipients. Provision of nutritional rehabilitation pre and post LVAD implant should be encouraged to enhance patient outcomes.