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Mechanical Circulatory Support in Patients with Heart Failure
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Mechanical Circulatory Support in Patients with Heart Failure

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 31 August 2024 | Viewed by 4512

Special Issue Editors

Dr. Arun K Singhal

E-Mail Website
Guest Editor
Department of Cardiothoracic Surgery, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
Interests: aortic valve fluid dynamics and repair; psychological preconditioning in cardiac transplant; cardiac surgery
Dr. Ernesto Ruiz Duque

E-Mail Website
Guest Editor
Department of Cardiothoracic Surgery, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
Interests: cardiogenic shock; mechanical circulatory support; extra-corporal membrane oxygenation; myocardial recovery; pulmonary hypertension and right ventricular failure; heart transplant immunosuppression surveillance

Special Issue Information

Dear Colleagues,

Heart failure is a severe cardiac condition, and mechanical circulatory support has emerged as an important therapeutic approach to assist or replace failing heart function through external devices. It has become a crucial strategy in improving the quality of life and survival rates of patients with heart failure.

This Special Issue will cover various aspects, including different types of mechanical circulatory support devices, treatment strategies, and technological advancements, as well as the latest research in the field. The aim of this Special Issue is to provide comprehensive information on the application and effectiveness of mechanical circulatory support in patients with heart failure for clinical practitioners and researchers.

Dr. Arun K Singhal
Dr. Ernesto Ruiz Duque
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • mechanical circulatory support
  • ECMO
  • impella
  • left ventricular assist device
  • heart failure
  • cardiogenic shock
  • microaxial support pump

Published Papers (5 papers)

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Research

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13 pages, 1250 KiB  
Article
The Influence of Arrhythmias and Metabolic Profile on Inpatient Mortality in Patients with Left Ventricular Assist Devices
by Daniel Antwi-Amoabeng, Bryce David Beutler and Tokunbo David Gbadebo
J. Clin. Med. 2024, 13(6), 1737; https://doi.org/10.3390/jcm13061737 - 17 Mar 2024
Viewed by 593
Abstract
Background: In patients with end-stage heart failure, durable Left Ventricular Assist Devices (LVADs) can be used as a bridge to transplant or destination therapy. LVADs have been shown to improve survival for patients with heart failure (HF). HF is associated with electrolyte abnormalities [...] Read more.
Background: In patients with end-stage heart failure, durable Left Ventricular Assist Devices (LVADs) can be used as a bridge to transplant or destination therapy. LVADs have been shown to improve survival for patients with heart failure (HF). HF is associated with electrolyte abnormalities and the development of sustained arrhythmias. However, data on the influence of arrhythmias and electrolyte imbalances on inpatient outcomes in LVAD patients are lacking. Furthermore, previous works assessing inpatient outcomes focused mainly on the role of chronic comorbidities in those outcomes. Methods: In this cross-sectional study, we used discharge data from the National Inpatient Sample from 2019 to 2020 to assess the influence of acute arrhythmias on inpatient mortality in patients with LVADs. We also investigated the relationship between acute medical conditions and mortality. Results: There were 9418 (not survey-adjusted) hospitalizations with LVAD, among which 2539 (27%) died during the hospitalization. Univariate analysis of arrhythmias showed that ventricular arrhythmias (VAs)—ventricular fibrillation/flutter and ventricular tachycardia—as well as complete heart block were associated with significantly higher odds of mortality. Follow-up multivariable logistic analysis showed that these arrhythmias retain their increased association with death. Hyperkalemia and acidosis had increased adjusted odds of death (1.54 (95% confidence interval: 1.28–1.85) (p < 0.001) and 2.44 (CI: 2.14–2.77) (p < 0.001), respectively). Conclusions: VAs, complete heart block, hyperkalemia, and acidosis were associated with increased odds of all-cause mortality. Females had higher odds of inpatient mortality. These findings suggest that electrolyte management, maintenance of optimal acid–base balance, and interventions to treat sustained ventricular arrhythmias may be suitable therapeutic targets to reduce mortality in hospitalized patients with LVADs. Full article
(This article belongs to the Special Issue Mechanical Circulatory Support in Patients with Heart Failure)
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10 pages, 2298 KiB  
Article
The Jena Method: Perfusionist Independent, Standby Wet-Primed Extracorporeal Membrane Oxygenation (ECMO) Circuit for Immediate Catheterization Laboratory and/or Hybrid Operating Room Deployment
by Franz Haertel, Mirko Kaluza, Jurgen Bogoviku, Julian Westphal, Michael Fritzenwanger, Ruediger Pfeifer, Daniel Kretzschmar, Torsten Doenst, Sven Moebius-Winkler and P. Christian Schulze
J. Clin. Med. 2024, 13(5), 1292; https://doi.org/10.3390/jcm13051292 - 24 Feb 2024
Viewed by 800
Abstract
Background: The timely initiation of extracorporeal membrane oxygenation (ECMO) is crucial for providing life support. However, delays can occur when perfusionists are not readily available. The Jena Method aims to address this issue by offering a wet-primed ECMO system that can be rapidly [...] Read more.
Background: The timely initiation of extracorporeal membrane oxygenation (ECMO) is crucial for providing life support. However, delays can occur when perfusionists are not readily available. The Jena Method aims to address this issue by offering a wet-primed ECMO system that can be rapidly established without the perfusionist’s presence. Methods: The goal was to ensure prompt ECMO initiation while maintaining patient safety. The method focuses on meeting hygienic standards, safe primed storage of the circuit, staff training, and providing clear step-by-step instructions for the ECMO unit. Results: Since implementing the Jena Method in 2015, 306 patients received VA-ECMO treatment. Bacterial tests confirmed the sterility of the primed ECMO circuits during a 14-day period. The functionality of all the components of the primed ECMO circuit after 14 days, especially the pump and oxygenator, were thoroughly checked and no malfunction was found to this day. To train staff for independent ECMO initiation, a step-by-step system involves safely bringing the ECMO unit to the intervention site and establishing all connections. This includes powering up, managing recirculation, de-airing the system, and preparing it for cannula connection. A self-developed picture-based guide assists in this process. New staff members learn from colleagues and receive quarterly training sessions by perfusionists. After ECMO deployment, the perfusionist provides a new primed system for a potential next patient. Conclusions: Establishing a permanently wet-primed on-demand extracorporeal life support circuit without direct perfusionist support is feasible and safe. The Jena Method enables rapid ECMO deployment and has the potential to be adopted in emergency departments as well. Full article
(This article belongs to the Special Issue Mechanical Circulatory Support in Patients with Heart Failure)
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Review

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15 pages, 243 KiB  
Review
Mechanical Circulatory Support Systems in the Management of Ventricular Arrhythmias: A Contemporary Overview
by Marco Valerio Mariani, Nicola Pierucci, Pietro Cipollone, Walter Vignaroli, Agostino Piro, Paolo Compagnucci, Andrea Matteucci, Cristina Chimenti, Claudio Pandozi, Antonio Dello Russo, Fabio Miraldi, Carmine Dario Vizza and Carlo Lavalle
J. Clin. Med. 2024, 13(6), 1746; https://doi.org/10.3390/jcm13061746 - 18 Mar 2024
Viewed by 770
Abstract
Ventricular tachycardias (VTs) and electrical storms (ES) are life-threatening conditions mostly seen in the setting of structural heart disease (SHD). Traditional management strategies, predominantly centered around pharmacological interventions with antiarrhythmic drugs, have demonstrated limited efficacy in these cases, whereas catheter ablation is related [...] Read more.
Ventricular tachycardias (VTs) and electrical storms (ES) are life-threatening conditions mostly seen in the setting of structural heart disease (SHD). Traditional management strategies, predominantly centered around pharmacological interventions with antiarrhythmic drugs, have demonstrated limited efficacy in these cases, whereas catheter ablation is related with more favorable outcomes. However, patients with hemodynamically unstable, recurrent VT or ES may present cardiogenic shock (CS) that precludes the procedure, and catheter ablation in patients with SHD portends a multifactorial intrinsic risk of acute hemodynamic decompensation (AHD), that is associated with increased mortality. In this setting, the use of mechanical circulatory support (MCS) systems allow the maintenance of end-organ perfusion and cardiac output, improving coronary flow and myocardial mechanics, and minimizing the effect of cardiac stunning after multiple VT inductions or cardioversion. Although ablation success and VT recurrence are not influenced by hemodynamic support devices, MCS promotes diuresis and reduces the incidence of post-procedural kidney injury. In addition, MCS has a role in post-procedural mortality reduction at long-term follow-up. The current review aims to provide a deep overview of the rationale and modality of MCS in patients with refractory arrhythmias and/or undergoing VT catheter ablation, underlining the importance of patient selection and timing for MCS and summarizing reported clinical experiences in this field. Full article
(This article belongs to the Special Issue Mechanical Circulatory Support in Patients with Heart Failure)
18 pages, 986 KiB  
Review
Mechanical Circulatory Support Systems in Fulminant Myocarditis: Recent Advances and Outlook
by Max Lenz, Konstantin A. Krychtiuk, Robert Zilberszac, Gottfried Heinz, Julia Riebandt and Walter S. Speidl
J. Clin. Med. 2024, 13(5), 1197; https://doi.org/10.3390/jcm13051197 - 20 Feb 2024
Viewed by 758
Abstract
Background: Fulminant myocarditis (FM) constitutes a severe and life-threatening form of acute cardiac injury associated with cardiogenic shock. The condition is characterised by rapidly progressing myocardial inflammation, leading to significant impairment of cardiac function. Due to the acute and severe nature of the [...] Read more.
Background: Fulminant myocarditis (FM) constitutes a severe and life-threatening form of acute cardiac injury associated with cardiogenic shock. The condition is characterised by rapidly progressing myocardial inflammation, leading to significant impairment of cardiac function. Due to the acute and severe nature of the disease, affected patients require urgent medical attention to mitigate adverse outcomes. Besides symptom-oriented treatment in specialised intensive care units (ICUs), the necessity for temporary mechanical cardiac support (MCS) may arise. Numerous patients depend on these treatment methods as a bridge to recovery or heart transplantation, while, in certain situations, permanent MCS systems can also be utilised as a long-term treatment option. Methods: This review consolidates the existing evidence concerning the currently available MCS options. Notably, data on venoarterial extracorporeal membrane oxygenation (VA-ECMO), microaxial flow pump, and ventricular assist device (VAD) implantation are highlighted within the landscape of FM. Results: Indications for the use of MCS, strategies for ventricular unloading, and suggested weaning approaches are assessed and systematically reviewed. Conclusions: Besides general recommendations, emphasis is put on the differences in underlying pathomechanisms in FM. Focusing on specific aetiologies, such as lymphocytic-, giant cell-, eosinophilic-, and COVID-19-associated myocarditis, this review delineates the indications and efficacy of MCS strategies in this context. Full article
(This article belongs to the Special Issue Mechanical Circulatory Support in Patients with Heart Failure)
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18 pages, 1499 KiB  
Review
Heart Transplantation
by Nikolaos Chrysakis, Dimitrios E. Magouliotis, Kyriakos Spiliopoulos, Thanos Athanasiou, Alexandros Briasoulis, Filippos Triposkiadis, John Skoularigis and Andrew Xanthopoulos
J. Clin. Med. 2024, 13(2), 558; https://doi.org/10.3390/jcm13020558 - 18 Jan 2024
Viewed by 1180
Abstract
Heart transplantation (HTx) remains the last therapeutic resort for patients with advanced heart failure. The present work is a clinically focused review discussing current issues in heart transplantation. Several factors have been associated with the outcome of HTx, such as ABO and HLA [...] Read more.
Heart transplantation (HTx) remains the last therapeutic resort for patients with advanced heart failure. The present work is a clinically focused review discussing current issues in heart transplantation. Several factors have been associated with the outcome of HTx, such as ABO and HLA compatibility, graft size, ischemic time, age, infections, and the cause of death, as well as imaging and laboratory tests. In 2018, UNOS changed the organ allocation policy for HTx. The aim of this change was to prioritize patients with a more severe clinical condition resulting in a reduction in mortality of people on the waiting list. Advanced heart failure and resistant angina are among the main indications of HTx, whereas active infection, peripheral vascular disease, malignancies, and increased body mass index (BMI) are important contraindications. The main complications of HTx include graft rejection, graft angiopathy, primary graft failure, infection, neoplasms, and retransplantation. Recent advances in the field of HTx include the first two porcine-to-human xenotransplantations, the inclusion of hepatitis C donors, donation after circulatory death, novel monitoring for acute cellular rejection and antibody-mediated rejection, and advances in donor heart preservation and transportation. Lastly, novel immunosuppression therapies such as daratumumab, belatacept, IL 6 directed therapy, and IgG endopeptidase have shown promising results. Full article
(This article belongs to the Special Issue Mechanical Circulatory Support in Patients with Heart Failure)
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