The use of continuous-flow left ventricular assist devices (LVADs) as therapy for patients with end-stage heart failure (HF) is growing rapidly, and overall outcomes are improving. This has prompted consideration of LVAD implantation slightly earlier in the clinical course of HF, in patients who have evidence of advanced disease but have not yet had obvious hemodynamic decompensation requiring ...

BACKGROUND In left ventricular assist device (LVAD) recipients, plasma levels of interleukin (IL)-6 are associated with Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles, reflecting post-operative risk. However, it is not clear how the cardiac level of IL-6, detectable on the tissue samples at the time of implantation, can contribute to predict the post-ope...

This study sought to investigate the effects of mechanical unloading on myocardial energetics and the metabolic perturbation of heart failure (HF) in an effort to identify potential new therapeutic targets that could enhance the unloading-induced cardiac recovery. The authors prospectively examined paired human myocardial tissue procured from 31 advanced HF patients at left ventricular assist d...

Background/Introduction Better understanding of hemodynamic alterations caused by long-term use of continuous-flow left ventricular assist devices (LVAD) is necessary to evaluate their impact onto the native heart and major vessels. In particular, aortic insufficiency is a known complication after LVAD implantation and may be related to alteration of pressure distribution on the leaflets of the...

below, most of the patients undergoing heart transplantation are on some form of LVAD as BTT. At first, extracorporeal devices were the norm. Implantable devices were initially only used as part of clinical trials, but BTT therapy using an implantable LVAD, allowing treatment at home, is increasingly coming into use since medical insurance coverage became available for nonpulsatile implantable ...

Background—More than 400 patients with end-stage heart failure underwent left ventricular assist device (LVAD) implantation of LVAD as destination therapy (DT) after the US Food and Drug Administration approval of DT in 2002. Because most of these patients had surgeries at hospitals that were newly accredited, we sought to examine the impact of LVAD center volume on the outcomes of DT. Methods ...

BACKGROUND Left ventricular assist devices (LVADs) are increasingly being used to "bridge" patients to heart transplantation. METHODS Data from 40 consecutive status 1 heart transplantation patients treated with intravenous inotrope therapy (n = 20) or the HeartMate LVAD (n = 20) were retrospectively analyzed. RESULTS Baseline clinical characteristics were similar in the two groups. At the ...

To assess whether the combined evaluation of total Sequential Organ Failure Assessment (t-SOFA) score and pro- and anti-inflammatory cytokine profiles early after left ventricular assist device (LVAD) implant discriminates patients at high risk for multiple organ failure syndrome (MOFS) in the first month post-LVAD, we analyzed plasma interleukin (IL)-6, IL-8, IL-10, IL-1ra, IL-1beta, tumor nec...

More than 5 million Americans are living with heart failure, with an additional 500 000 cases diagnosed each year.1 Ongoing improvements in patient management will only increase the number of patients surviving to develop severe refractory heart failure (stage D). Approximately 5% to 10% of all heart failure patients are classified as stage D and defined as patients who continue to have symptom...

In this issue of Circulation, Birks et al1 report their recent experience using the combination of continuous-flow (CF) circulatory support and pharmacological therapy to treat advanced heart failure in patients requiring left ventricular assist device (LVAD) support. Thirty-three patients underwent HeartMate II (HMII) LVAD implantation at Harefield hospital during the 3-year study period. Twen...