Minimally-invasive LVAD Implantation: State of the Art

Nowadays, the worldwide number of left ventricular assist devices (LVADs) being implanted per year is higher than the number of cardiac transplantations. The rapid developments in the field of mechanical support are characterized by continuous miniaturization and enhanced performance of the pumps, providing increased device durability and a prolonged survival of the patients. The miniaturization process enabled minimally-invasive implantation methods, which are associated with generally benefitting the overall outcome of patients. Therefore, these new implantation strategies are considered the novel state of the art in LVAD surgery.In this paper we provide a comprehensive review on the existing literature on minimally-invasive techniques with an emphasis on the different implantation approaches and their individual surgical challenges.     

Intensive care of the adult patient with congenital heart disease

Prevalence of congenital heart disease in the adult population has increased out of proportion to that of the pediatric population as survival has improved, and adult congenital heart disease patients make up a growing percentage of pediatric and adult cardiac intensive care unit admissions. These patients often develop complex multiorgan system disease as a result of long-standing altered cardiac physiology, and many require reoperation during adulthood. Practitioners who care for these patients in the cardiac intensive care unit must have a strong working knowledge of the pathophysiology of complex congenital heart disease, and a full team of specialists must be available to assist in the care of these patients. This chapter will review some of the common multiorgan system effects of long-standing congenital heart disease (eg, renal and hepatic dysfunction, coagulation abnormalities, arrhythmias) as well as some of the unique cardiopulmonary physiology of this patient population.     

艾迪注射液联合VAD方案治疗老年多发性骨髓瘤的临床研究

目的观察艾迪注射液联合VAD方案治疗老年多发性骨髓瘤的临床疗效。方法将55例老年多发性骨髓瘤患者随机分为治疗组（28例）和对照组（27例）,治疗组应用艾迪注射液联合VAD方案,对照组单用VAD方案,4周为1个疗程,3个疗程后行近期疗效评价。比较两组的疗效、不良反应及对患者生活质量的影响。结果治疗组与对照组治疗的总有效率分别为67.86%及62.96%,两组差异无统计学意义（P〉0.05）;治疗组不良反应减少,生活质量提高,两组比较差异有统计学意义（P〈0.05）。结论艾迪注射液联合VAD方案治疗老年多发性骨髓瘤有效,不良反应少,在改善患者生活质量方面有较好的疗效,值得临床推广应用     

BD 方案与VAD 方案治疗多发性骨髓瘤的疗效比较

 目的比较硼替佐米联合地塞米松方案（BD方案）与VAD 方案治疗多发性骨髓瘤的临床疗效及安全性。方法回顾性
分析120 例多发性骨髓瘤病例,根据其治疗方案分为：（1）BD 组（ n=37）：其中初治16 例,复发/难治21 例;（2）VAD 组（ n=83）：
其中初治39 例,复发/难治44 例。化疗4~7 个疗程后全面评价两组疗效及副反应。采用EBMT/ABMT 标准判定疗效,并按WHO
标准判断不良反应。结果（1）BD组：中位生存期为43.5 个月,2 年和4 年生存率分别为86.4%和47.3%,平均起效疗程数为
2.06,总有效率为91.9%,其中CR/nCR 32.4%（12/37）,PR 48.6%（18/37）,MR 10.8%（4/37）。初治患者CR/nCR 37.5%（6/16）,
PR 50.0%（8/16）,MR 6.3%（1/16）,NR 6.3%（1/16）,有效率为93.8%;复发/难治患者CR/nCR 28.6%（6/21）,PR 47.6%（10/
21）,MR 14.3%（3/21）,NR 4.8%（1/21）,PD 4.8%（1/21）,有效率为90.5%;（2）VAD 组：中位生存期为29.1 个月,2 年和4 年生
存率分别为64.3%和33.5%,平均起效疗程数为3.09,总有效率为66.3%,其中CR/nCR 12.0%（10/83）,PR 38.6%（32/83）,MR
15.7%（13/83）。初治患者CR/nCR 15.4%（6/39）,PR 38.5%（15/39）,MR 12.8%（5/39）,NR 20.5%（8/39）,PD 12.8%（5/39）,有
效率66.7%;复发/难治患者CR/nCR 9.1%（4/44）,PR 38.6%（17/44）,MR 18.2%（8/44）,NR 18.2%（8/44）,PD 15.7%（7/44）,有
效率为65.9%。字2检验结果显示,2 组方案疗效之间比较差异有统计学意义（ < 0.05）;经Log-rank 检验发现,2 组生存率比较差
异有统计学意义（ < 0.05）;（3）与VAD组相比,BD 组不良反应较轻微,患者耐受性较好。结论与VAD方案相比,BD方案能
达到更高的缓解率,显著延长患者的生存期,并提高患者的生活质量,疗效显著,毒副反应小,耐受性好。     

Narrative medicine applications for patient identity and quality of life in ventricular assist device (VAD) patients

Patients with advanced heart failure may experience a variety of challenges to their self-identity and quality of life due to their heart condition and treatment by implantation of a ventricular assist device (VAD). These challenges include loss of energy and stamina, loss of independence and autonomy, dependence on loved ones and caregivers for help, strained relationships with family and friends, and uncertainty about treatment outcomes and time of recovery. Narrative Medicine (NM) sessions may help patients to reflect on their situation, rediscover identity, and engage sources of meaning by telling or writing their story. This narrative process may encourage patient resilience and quality of life. The impact of illness and treatment on each patient may be understood more fully in light of each patient's unique identity and life story. Insights from NM visits may also help the treatment team as they assess patients' life situation including sources of support as well as goals and motivation for treatment. This paper provides case reports to illustrate applications of NM in the care of patients with advanced heart failure who are treated with implanted VADs. The cases include use of NM to clarify an elderly patient's motivation and consent for VAD implantation to return to favorite outdoor activities; application of perspectives from NM visits to appreciate a patient's slow but gradual improvement after VAD implantation and strong motivation for recovery; and use of a NM session to help a patient begin to overcome social withdrawal and fear after traumatic post-operative experiences.     

Clinical stage-depending decrease of NK cell activity in multiple myeloma patients

Natural killer cells, as an important subpopulation of cells of the innate immune system have an essential role in defense of the rise and spread of malignancy. These cells have a CD3-CD16 + CD56+ phenotype and they are functionally defined by their ability to lyses tumor cells. We here show that decrease of NK cell activity was significantly associated with advanced clinical stage, increased lactate dehydrogenase (LDH), percentage infiltration of bone marrow with plasma cells, and β-2 microglobulin. The patients with higher NK cell activity at presentation after receiving VAD protocol have better cumulative survival in comparison with those with low NK cell activity.     

沙利度胺联合VAD治疗难治或复发性多发性骨髓瘤的临床观察

目的观察沙利度胺联合VAD治疗难治性或复发性多发性骨髓瘤(MM)的临床疗效及不良反应。方法 49例患者难治性或复发性MM患者随机分为沙利度胺联合VAD组(n=25)和VAD组(n=24)。A组:25例患者接受沙利度胺联合VAD化疗方案(VAD:(长春新碱0.4 mg/d静脉注射,第1～4 d;多柔比星10 mg/d静脉注射,第1～4 d;地塞米松40 mg/d口服,第1～4d,9-12 d和第17～20 d);沙利度胺200 mg/d口服)。B组:24例患者接受VAD方案(同上)。每治疗周期为28 d,持续4个周期后评价治疗效果。结果 A组和B组最终病例数分别为25例和23例(B组1例男性患者死亡)。2组的治疗有效率分别为80%和47.8%,A组的疗效明显优于B组(P<0.05)。A组较B组更容易产生便秘、嗜睡(P<0.05),2组患者的副反应程度均可耐受。结论沙利度胺联合VAD较单纯VAD方案治疗难治性或复发性MM具有更好的治疗效果,患者能够很好的耐受。     

全球心室辅助装置临床试验注册现状分析

目的:分析全球心室辅助装置(VAD)相关临床试验注册现状,为VAD的产品开发及临床应用提供数据支持.方法:在ClinicalTrials.gov数据库中检索VAD相关临床试验数据,利用文献计量学方法,基于数量与时间变化趋势、国家分布、申办者分布及构成、研究类型及研究设计、临床试验分期和研究疾病等多角度,对VAD相关临床...     

Treatment of multiple organ failure by a totally implantable ventricular assist device

Multiple organ failure (MOF) becomes an important problem during clinical use of the ventricular assist device (VAD). To improve the clinical record of the VAD, the function of other organs may be vitally important. For that reason, we have been developing a VAD system aiming at improving the function of other organs. Development of the vibrating flow pump (VFP), which can generate a unique flow pattern from 10 to 50Hz, is still ongoing in our institute. In order to evaluate brain blood flow and oxygen consumption, oxyhemoglobin was measured with NIRO (Hamamatsu Photo.) in healthy adult goats. Four healthy adult goats were anesthetized with halothane inhalation, and left thoracotomy was performed for left heart bypass. Oxyhemoglobin in the brain was measured with the recording of the hemodynamic variables during left heart assistance with the VFP system. During left heart bypass with the VFP system, the hemodynamic parameters kept within the normal range, and satisfactory pump output was easily obtained. Pump output was kept within 40%–50% bypass to evaluate the effect of high-frequency oscillating assist flow on brain blood flow with the same cardiac output. Interesting results were observed during the experiments. During 30Hz driving of the VFP left heart assistance, oxyhemoglobin suggested that brain blood flow was significantly increased compared with another drive frequency with the same total cardiac output. These results suggest that we can control brain blood flow with a totally implantable VAD system such as the VFP system, which can control the frequency of the blood flow. Presented in part at the 7th Congress of the International Society for Rotary Blood Pumps, August 26–28, 2000, in Tokyo, Japan