Transcatheter left ventricular assist pump (LVAP) is widely used in cardiogenic shock, post-circulatory hypoperfusion syndrome and high-risk percutaneous coronary intervention (PCI), and its application scenarios cover various complex environments such as ICU, operating room, emergency department and catheterization room. It is important to quickly and accurately implant the transcatheter LVAP and monitor its position in real time. This paper reported 2 male patients with high-risk PCI, aged 47 and 45 years, both with triple coronary artery disease and reduced ejection fraction (<35%). The domestically produced transcatheter LVAP was implanted using an echocardiography guidance technology system, and PCI treatment was performed under the assistance of the interventional pump. The operation was smooth, and the interventional pump assisted for 1 h in 2 patients, and the pump was successfully removed. There were no obvious complications related to the pump and PCI after the operation, and the patients were discharged smoothly.
Objective To compare the clinical characteristics and prognosis of patients who received two different intraventricular repair. Methods We retrospectively analyzed the clinical data of 24 complete transposition of the great arteries (TGA)/left ventricular outflow tract obstruction (LVOTO) patients who all received intraventricular repair. The patients were allocated into two groups including a REV group and a Rastelli group. There were 13 patients with 9 males and 4 females at median age of 25.2 (6, 72) months in the REV group. There were 11 patients with 10 males and 1 female at median age of 47.9 (14, 144) months in the Rastelli group. Results The age at operation (P=0.041), pulmonary valve Z value (P=0.002), and LVOT gradient (P=0.004), rate of multiphase operation between the REV group and the Rastelli group was statistically different. The mean follow-up time was 17.3 months. And during the follow-up, 1 patient had early mortality, 2 patients had early reintervention, 7 patients had postoperative RVOTO, and received Rastelli and larger VSD inner diameter were associated with postoperative RVOTO. Conclusion As the traditional surgery for TGA/LVOTO patients, the intraventricular repair has a low early mortality and low early reintervention. Modified REV is associated with postoperative peripheral pulmonary vein isolation (PVIS). Patients who received Rastelli operation and with larger VSD inner diameter are more likely to have postoperative RVOTO, but the reintervention for PVI and RVOTO during follow up is very low.
Although extracorporeal membrane oxygenation (ECMO) has been in existence since the 1970s as a means of supporting respiratory or cardiac function, early application of this technology was plagued by high complication rates. Peripheral veno-arterial extracorporeal membrane oxygenation (V-A ECMO) causes higher left ventricular end-diastolic pressure, pulmonary edema, left ventricular distention, ventricular arrhythmia, low coronary perfusion, myocardial ischemia, substantial thrombus formation within left ventricule cavity and even multiple organ dysfunction. Mechanical left ventricular decompression is required to treat these related complications. In this article, we reviewed the problems associated with left ventricular decompression supported by peripheral V-A ECMO in patients with cardiogenic shock.
Objective To investigate the left ventricular reverse remodeling (LVRR) in patients with aortic valve insufficiency with reduced ejection fraction (AIrEF) and aortic valve insufficiency with preserved ejection fraction (AIpEF) after transcatheter aortic valve replacement (TAVR). MethodsThe clinical and follow-up data of patients who underwent TAVR in the Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from 2018 to 2021 were retrospectively analyzed. According to the guideline, the patients with left ventricular ejection fraction<55% were allocated to an AIrEF group, and the patients with left ventricular ejection fraction≥55% were allocated to an AIpEF group. ResultsA total of 50 patients were enrolled. There were 19 patients in the AIrEF group, including 15 males and 4 females with a mean age of 74.5±7.1 years. There were 31 patients in the AIpEF group, including 19 males and 12 females with a mean age of 72.0±4.8 years. All patients underwent TAVR successfully. Echocardiographic results showed that TAVR significantly promoted LVRR in the patients. Significant LVRR occurred in the early postoperative period (the first day after the surgery) in both groups. It remained relatively stable after the LVRR in the early postoperative period (the first day after surgery) in the AIpEF patients, while it continued to occur in the early postoperative period (the first day after surgery) to three months after the surgery in the AIrEF patients, and then remained relatively stable. Compared to preoperative values, AIrEF patients had a reduction in the average left ventricular end-diastolic volume index and left ventricular end-systolic volume index by 16.8 mL/m2 (P=0.003) and 8.6 mL/m2 (P=0.005), respectively, and the average left ventricular end-diastolic diameter index and end-systolic diameter index decreased by 2.5 mm/m2 (P=0.003) and 1.9 mm/m2 (P=0.003), respectively on the first day after the surgery. In comparison to the first day after the surgery, AIrEF patients experienced an average increase of 12.1% in the left ventricular ejection fraction three months after the surgery (P＜0.001). ConclusionTAVR has achieved good therapeutic effects in patients with aortic valve insufficiency, significantly promoting the LVRR in patients, and has better curative effects in AIrEF patients.
The rotary left ventricular assist device (LVAD) has been an effective option for end-stage heart failure. However, while clinically using the LVAD, patients are often at significant risk for ventricular collapse, called suction, mainly due to higher LVAD speeds required for adequate cardiac output. Some proposed suction detection algorithms required the external implantation of sensors, which were not reliable in long-term use due to baseline drift and short lifespan. Therefore, this study presents a new suction detection system only using the LVAD intrinsic blood pump parameter (pump speed) without using any external sensor. Three feature indices are derived from the pump speed and considered as the inputs to four different classifiers to classify the pumping states as no suction or suction. The in-silico results using a combined human circulatory system and LVAD model show that the proposed method can detect ventricular suction effectively, demonstrating that it has high classification accuracy, stability, and robustness. The proposed suction detection system could be an important part in the LVAD for detecting and avoiding suction, while at the same time making the LVAD meet the cardiac output demand for the patients. It could also provide theoretical basis and technology support for designing and optimizing the control system of the LVAD.
Implantable left ventricular assist device (LVAD) has become an essential treatment for end-stage heart failure, and its effect has been continuously improved. In the world, magnetic levitation LVAD has become mainstream and is increasingly used as a destination treatment. China has also entered the era of ventricular assist device. The continuous improvement of the ventricular assist device will further improve the treatment effect. This article reviews the current situation and development trend of LVAD treatment in China and abroad.
Objective To compare the clinical efficacy of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with coronary heart disease and left ventricular systolic dysfunction. Methods A computer-based search in PubMed, The Cochrane Library and EMbase up to October 2017, together with reference screening, was performed to identify eligible clinical trials, cohort studies and case-control studies. The outcomes of this meta-analysis included all-cause mortality, myocardial infarction, revascularization and stroke, and the effect sizes for them were presented as relative risk (RR) with its 95% confidence intervals (CI). Results Fifteen cohort studies and 2 randomized controlled trials were finally included with a total of 11 985 patients, of whom 6 322 were in the CABG group and 5 663 in the PCI group. The result of meta-analysis showed that all-cause mortality was significantly lower in the CABG group than that in the PCI group (18.6% vs. 23.0%, RR=0.87, 95% CI 0.81 to 0.94, P<0.001). In addition, CABG was associated with a remarkably reduced risk of revascularization (RR=0.28, 95% CI 0.19 to 0.42, P<0.001) compared with PCI, with no significant difference in incidence of myocardial infarction (RR=0.78, 95% CI 0.47 to 1.32, P=0.36) and stroke (RR=1.28, 95% CI 0.89 to 1.86, P=0.18). Conclusion CABG is superior to PCI in the treatment for patients with coronary heart disease and left ventricular systolic dysfunction. Owing to the limited quality of included studies, additional large, randomized controlled trails are still required to confirm this finding.
Objective To compare the early outcomes of domestic third-generation magnetically levitated left ventricular assist device (LVAD) with or without concomitant mitral valvuloplasty (MVP). Methods The clinical data of 17 end-stage heart failure patients who underwent LVAD implantation combined with preoperative moderate to severe mitral regurgitation in Fuwai Central China Cardiovascular Hospital from May 2018 to March 2023 were retrospectively analyzed. The patients were divided into a LVAD group and a LVAD+MVP group based on whether MVP was performed simultaneously, and early outcomes were compared between the two groups. Results There were 4 patients in the LVAD group, all males, aged (43.5±5.9) years, and 13 patients in the LVAD+MVP group, including 10 males and 3 females, aged (46.8±16.7) years. All the patients were successful in concomitant MVP without mitral reguragitation occurrence. Compared with the LVAD group, the LVAD+MVP group had a lower pulmonary artery systolic pressure and pulmonary artery mean pressure 72 h after operation, but the difference was not statistically different (P>0.05). Pulmonary artery systolic pressure was significantly lower 1 week after operation, as well as pulmonary artery systolic blood pressure and pulmonary artery mean pressure at 1 month after operation (P<0.01). There was no statistically significant difference in blood loss, operation time, cardiopulmonary bypass time, aortic cross-clamping time, mechanical ventilation time, or ICU stay time between the two groups (P>0.05). The differences in 1-month postoperative mortality, acute kidney injury, reoperation, gastrointestinal bleeding, and thrombosis and other complications between the two groups were not statistically significant (P>0.05). Conclusion Concomitant MVP with implantation of domestic third-generation magnetically levitated LVAD is safe and feasible, and concomitant MVP may improve postoperative hemodynamics without significantly increasing perioperative mortality and complication rates.
Regurgitation is an abnormal condition happens when left ventricular assist devices (LVADs) operated at a low speed, which causes LVAD to fail to assist natural blood-pumping by heart and thus affects patients’ health. According to the degree of regurgitation, three LVAD’s regurgitation states were identified in this paper: no regurgitation, slight regurgitation and severe regurgitation. Regurgitation index (RI), which is presented based on the theory of dynamic closed cavity, is used to grade the regurgitation of LVAD. Numerical results showed that when patients are in exercising, resting and sleeping state, the critical speed between slight regurgitation and no regurgitation are 6 650 r/min, 7 000 r/min and 7 250 r/min, respectively, with corresponding RI of 0.401, 0.300 and 0.238, respectively. And the critical speed between slight regurgitation and severe regurgitation are 5 500 r/min, 6 000 r/min and 6 450 r/min, with corresponding RI of 0.488, 0.359 and 0.284 respectively. In addition, there is a negative relation correction between RI and rotational speed, so that grading the LVAD’s regurgitation can be achieved by determining the corresponding critical speed. Therefore, the detective parameter RI based on the signal of flow is proved to be able to grade LVAD’s regurgitation states effectively and contribute to the detection of LVAD’s regurgitation, which provides theoretical basis and technology support for developing a LVADs controlling system with high reliability.
Objective To explore the risk factors for long-term death of patients with acute myocardial infarction (AMI) and reduced left ventricular ejection fraction (LVEF), and develop and validate a prediction model for long-term death. Methods This retrospective cohort study included 1013 patients diagnosed with AMI and reduced LVEF in West China Hospital of Sichuan University between January 2010 and June 2019. Using the RAND function of Excel software, patients were randomly divided into three groups, two of which were combined for the purpose of establishing the model, and the third group was used for validation of the model. The endpoint of the study was all-cause mortality, and the follow-up was until January 20th, 2021. Cox proportional hazard model was used to evaluate the risk factors affecting the long-term death, and then a prediction model based on those risk factors was established and validated. Results During a median follow-up of 1377 days, 296 patients died. Multivariate Cox regression analysis showed that age≥65 years [hazard ratio (HR)=1.842, 95% confidence interval (CI) (1.067, 3.179), P=0.028], Killip class≥Ⅲ[HR=1.941, 95%CI (1.188, 3.170), P=0.008], N-terminal pro-brain natriuretic peptide≥5598 pg/mL [HR=2.122, 95%CI (1.228, 3.665), P=0.007], no percutaneous coronary intervention [HR=2.181, 95%CI (1.351, 3.524), P=0.001], no use of statins [HR=2.441, 95%CI (1.338, 4.454), P=0.004], and no use of β-blockers [HR=1.671, 95%CI (1.026, 2.720), P=0.039] were independent risk factors for long-term death. The prediction model was established and patients were divided into three risk groups according to the total score, namely low-risk group (0-2), medium-risk group (4-6), and high-risk group (8-12). The results of receiver operating characteristic curve [area under curve (AUC)=0.724, 95%CI (0.680, 0.767), P<0.001], Hosmer-Lemeshow test (P=0.108), and Kaplan-Meier survival curve (P<0.001) showed that the prediction model had an efficient prediction ability, and a strong ability in discriminating different groups. The model was also shown to be valid in the validation group [AUC=0.758, 95%CI (0.703, 0.813), P<0.001]. Conclusions In patients with AMI and reduced LVEF, age≥65 years, Killip class≥Ⅲ, N-terminal pro-brain natriuretic peptide≥5598 pg/mL, no percutaneous coronary intervention, no use of statins, and no use of β-blockers are independent risk factors for long-term death. The developed risk prediction model based on these risk factors has a strong prediction ability.
