- Email: [email protected]
Renal and Hepatic Function Improve in Advanced Heart Failure Patients during Continuous Flow Support with the HeartMate II LVAD
S116 Journal of Cardiac Failure Vol. 13 No. 6 Suppl. 2007 later, data was collected with atrial pacing alone, as well as borderzone pacing at several of A-V delays. Results: With borderzone pacing, the borderzone contracts more quickly to a value which is held through the period of maximal left ventricular pressure (Figure). While the average rate of contraction during systole is similar between the two conditions (0.048 mm2/msec atrially paced and 0.047 mm2/msec AV paced), the initial contraction in the borderzone paced condition occurs at 0.125 mm2/msec while the same contraction occurs at 0.057 mm2/sec in the atrially paced condition. The regional afterload of the paced segement early in systole is reduced as it occurs before the left ventricular pressure rises. By conservation of mass, the region is thicker than it would be otherwise, further reducing wall stress for a given afterload. Conclusion: In this study, borderzone pacing allows reduction of wall stress, both by decreasing regional afterload early in systole and by distributing that wall stress which cannot be avoided over a thicker surface. This may provide a minimally invasive approach to preventing adverse remodeling after MI.
a large multicenter series of heart failure patients. Methods: We evaluated renal (creatinine and blood urea nitrogen, BUN) and hepatic (ALT, Total bilirubin) function in 231 advanced heart failure patients before and after implantation with the HeartMate II continuous flow LVAD for bridge to transplantation at 35 centers. Results: There were 179 males and 52 females with a median age of 55 (range 15-69). Median BUN was reduced 27% below baseline at LVAD month 1, and continued to improve, stabilizing at 19.8 mg/dL at month 3. Cr fell 17% to 1.18 mg/dL at month 1, and remained stable thereafter. ALT decreased 63% at month 1, and stabilized. T bili was mildly elevated at baseline and after an acute increase at week 1, decreased by 38% from baseline at month 3. Conclusion: The HeartMate II continuous flow LVAD improves renal and hepatic function in advanced heart failure patients, without any evidence of detrimental effects from reduced pulsatility. Baseline Creatinine (mg/dL) BUN (mg/dL) ALT (U/L) T Bili (mg/dL)
7 days
Month 1
Month 2
Month 3
1.42 6 0.54 1.27 6 0.66 1.18 6 0.56 1.16 6 0.47 1.17 6 0.65 30.6 6 17.9 28.0 6 18.7 22.2 6 18.0 20.8 6 12.9 19.8 6 9.9 100 6 256 74 6 149 37 6 40 31 6 20 32 6 25 1.24 6 0.76 2.66 6 3.85 1.38 6 3.41 0.99 6 1.70 0.77 6 0.46
mean 6 SD.
145 Outcome of Heart Transplantation in Patients with Sarcoid Cardiomyopathy Ali R. Zaidi1, Asim R. Zaidi2, Paul Vaitkus3; 1Department of Medicine, University of Illinois, Chicago, IL; 2Department of Medicine, St. George’s Hospital, London, United Kingdom; 3Midwest Heart Specialists, Rockford, IL Background: Cardiac transplantation has been increasingly used in patients with sarcoid cardiomyopathy. We sought to review outcomes in patients with sarcoidosis who had heart transplants and compare these outcomes to transplanted patients without sarcoidosis. Methods: We retrospectively reviewed the United Network for Organ Sharing (UNOS) database to assess the survival of patients with sarcoidosis who were treated by heart transplantation. Results: Over an 18-year period, 65 (40 men and 25 women) patients with sarcoidosis received orthotopic heart. There were 4 operative deaths and 12 late deaths at a mean follow-up of 40 months. One year post transplant survival was significantly better for sarcoid patients receiving orthotopic transplantation compared to contemporaneous patients receiving transplantation for all other diagnoses (87.7% vs 84.5%, p 5 0.030). Conclusions: Patients with sarcoidosis undergoing orthotopic heart transplant had a short and intermediate-term survival rate that was better than the majority of heart-transplant recipients. The diagnosis of sarcoidosis should not disqualify potential transplant candidates.
Patients with mild and moderate baseline renal insufficiency, improvement begins by day 7-14, but continues through day 60. Despite significantly different (p 5 0.0001) baseline Cr, by day 60 there is no difference in Cr between the group with mild (1.5 !5 Cr ! 2.2) and moderate (Cr O5 2.2) renal dysfunction (p 5 0.59).
146 144 Renal and Hepatic Function Improve in Advanced Heart Failure Patients during Continuous Flow Support with the HeartMate II LVAD Stuart D. Russell1, David B. Dyke2, Juan M. Aranda3, Andrew J. Boyle4, Joseph G. Rogers5, David J. Farrar6, John V. Conte1, HeartMate II Investigators; 1Medicine and Surgery, Johns Hopkins Hospital, Baltimore, MD; 2Medicine, University of Michigan, Ann Arbor, MI; 3Medicine, University of Florida, Gainesville, FL; 4 Medicine, University of Minnesota, Minneapolis, MN; 5Medicine, Duke University, Durham, NC; 6Thoratec Corporation, Pleasanton, CA Introduction: The effects of continuous flow left ventricular assist devices (LVADs) and reduced pulsatility on major organ function has not been studied in detail in
Non-Invasive Output Measurement of Cardiac Assist Devices Using Quantitative Contrast Doppler Echocardiography Karl Q. Schwarz1, Xucai Chen1, Sherry Steinmetz1, William Hallinan1, David Farrar2, H. Todd Massey1, Leway Chen1, Sridevi Ramamurthi1; 1Cardiology Division, University of Rochester, Rochester, NY; 2Thoratec Corporation, Pleasanton, CA Background: Many implantable ventricular assist devices (VADs) that are currently clinically available have no direct measurement of pump output; instead they estimate output using calculations based on indirect measures, such as power consumed and pump speed, or VAD rate and stroke volume. The hypothesis tested in this protocol is that quantitative contrast Doppler echocardiography can be used to accurately measure the output of VAD devices compared to independent flow measurements.
a large multicenter series of heart failure patients. Methods: We evaluated renal (creatinine and blood urea nitrogen, BUN) and hepatic (ALT, Total bilirubin) function in 231 advanced heart failure patients before and after implantation with the HeartMate II continuous flow LVAD for bridge to transplantation at 35 centers. Results: There were 179 males and 52 females with a median age of 55 (range 15-69). Median BUN was reduced 27% below baseline at LVAD month 1, and continued to improve, stabilizing at 19.8 mg/dL at month 3. Cr fell 17% to 1.18 mg/dL at month 1, and remained stable thereafter. ALT decreased 63% at month 1, and stabilized. T bili was mildly elevated at baseline and after an acute increase at week 1, decreased by 38% from baseline at month 3. Conclusion: The HeartMate II continuous flow LVAD improves renal and hepatic function in advanced heart failure patients, without any evidence of detrimental effects from reduced pulsatility. Baseline Creatinine (mg/dL) BUN (mg/dL) ALT (U/L) T Bili (mg/dL)
7 days
Month 1
Month 2
Month 3
1.42 6 0.54 1.27 6 0.66 1.18 6 0.56 1.16 6 0.47 1.17 6 0.65 30.6 6 17.9 28.0 6 18.7 22.2 6 18.0 20.8 6 12.9 19.8 6 9.9 100 6 256 74 6 149 37 6 40 31 6 20 32 6 25 1.24 6 0.76 2.66 6 3.85 1.38 6 3.41 0.99 6 1.70 0.77 6 0.46
mean 6 SD.
145 Outcome of Heart Transplantation in Patients with Sarcoid Cardiomyopathy Ali R. Zaidi1, Asim R. Zaidi2, Paul Vaitkus3; 1Department of Medicine, University of Illinois, Chicago, IL; 2Department of Medicine, St. George’s Hospital, London, United Kingdom; 3Midwest Heart Specialists, Rockford, IL Background: Cardiac transplantation has been increasingly used in patients with sarcoid cardiomyopathy. We sought to review outcomes in patients with sarcoidosis who had heart transplants and compare these outcomes to transplanted patients without sarcoidosis. Methods: We retrospectively reviewed the United Network for Organ Sharing (UNOS) database to assess the survival of patients with sarcoidosis who were treated by heart transplantation. Results: Over an 18-year period, 65 (40 men and 25 women) patients with sarcoidosis received orthotopic heart. There were 4 operative deaths and 12 late deaths at a mean follow-up of 40 months. One year post transplant survival was significantly better for sarcoid patients receiving orthotopic transplantation compared to contemporaneous patients receiving transplantation for all other diagnoses (87.7% vs 84.5%, p 5 0.030). Conclusions: Patients with sarcoidosis undergoing orthotopic heart transplant had a short and intermediate-term survival rate that was better than the majority of heart-transplant recipients. The diagnosis of sarcoidosis should not disqualify potential transplant candidates.
Patients with mild and moderate baseline renal insufficiency, improvement begins by day 7-14, but continues through day 60. Despite significantly different (p 5 0.0001) baseline Cr, by day 60 there is no difference in Cr between the group with mild (1.5 !5 Cr ! 2.2) and moderate (Cr O5 2.2) renal dysfunction (p 5 0.59).
146 144 Renal and Hepatic Function Improve in Advanced Heart Failure Patients during Continuous Flow Support with the HeartMate II LVAD Stuart D. Russell1, David B. Dyke2, Juan M. Aranda3, Andrew J. Boyle4, Joseph G. Rogers5, David J. Farrar6, John V. Conte1, HeartMate II Investigators; 1Medicine and Surgery, Johns Hopkins Hospital, Baltimore, MD; 2Medicine, University of Michigan, Ann Arbor, MI; 3Medicine, University of Florida, Gainesville, FL; 4 Medicine, University of Minnesota, Minneapolis, MN; 5Medicine, Duke University, Durham, NC; 6Thoratec Corporation, Pleasanton, CA Introduction: The effects of continuous flow left ventricular assist devices (LVADs) and reduced pulsatility on major organ function has not been studied in detail in
Non-Invasive Output Measurement of Cardiac Assist Devices Using Quantitative Contrast Doppler Echocardiography Karl Q. Schwarz1, Xucai Chen1, Sherry Steinmetz1, William Hallinan1, David Farrar2, H. Todd Massey1, Leway Chen1, Sridevi Ramamurthi1; 1Cardiology Division, University of Rochester, Rochester, NY; 2Thoratec Corporation, Pleasanton, CA Background: Many implantable ventricular assist devices (VADs) that are currently clinically available have no direct measurement of pump output; instead they estimate output using calculations based on indirect measures, such as power consumed and pump speed, or VAD rate and stroke volume. The hypothesis tested in this protocol is that quantitative contrast Doppler echocardiography can be used to accurately measure the output of VAD devices compared to independent flow measurements.