Journal ArticleDOI
Are blood stream infections associated with an increased risk of hemorrhagic stroke in patients with a left ventricular assist device
Ashim Aggarwal,Ankit Gupta,Shivani Kumar,Jane A. Baumblatt,Sunil Pauwaa,Colleen Gallagher,Adam N. Treitman,Pat S Pappas,Antone Tatooles,Geetha Bhat +9 more
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TLDR
Advanced HF patients with LVAD support who developed BSI need urgent evaluation and close monitoring for suspected neurological complications, particularly hemorrhagic CVA.Abstract:
Blood stream infections (BSIs) are an important cause of morbidity and mortality in patients with left ventricular assist devices (LVADs). The aim of this study was to examine the correlation between hemorrhagic cerebrovascular accident (CVA) and BSI after implantation of LVAD for advanced heart failure (HF). This was a retrospective descriptive review of 87 patients with end-stage HF, who underwent implantation of HeartMate II continuous-flow LVAD over a 4 year period. Blood stream infections were diagnosed by serial blood cultures, and suspected neurological complications including CVAs were confirmed by neuroimaging. Extensive patient chart review was performed, and descriptive characteristics were analyzed using SPSS statistical software. The mean age of our study population was 62.3 ± 12.8 years, and the majority of our patients were males (n = 75, 86.2%). The baseline characteristics were comparable in the patients with and without CVAs. Patients with BSI had a much greater incidence of CVA compared to patients without BSI (n = 13, 43.3% vs. n = 5, 10.0%; p 20-fold risk of hemorrhagic CVA (OR = 24; 95% CI = 2.8-201.1; p = 0.03). Advanced HF patients with LVAD support who developed BSI need urgent evaluation and close monitoring for suspected neurological complications, particularly hemorrhagic CVA.read more
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Journal ArticleDOI
2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association
Dawn Kleindorfer,Amytis Towfighi,Seemant Chaturvedi,Kevin M. Cockroft,Jose Gutierrez,Debbie Lombardi-Hill,Hooman Kamel,Walter N. Kernan,Steven J. Kittner,Enrique C. Leira,Olive Lennon,James F. Meschia,Thanh N. Nguyen,Peter M. Pollak,Pasquale Santangeli,Anjail Sharrief,Sidney C. Smith,Tanya N. Turan,Linda S. Williams +18 more
Journal ArticleDOI
The HVAD Left Ventricular Assist Device: Risk Factors for Neurological Events and Risk Mitigation Strategies
Jeffrey J. Teuteberg,Mark S. Slaughter,Joseph G. Rogers,Edwin C. McGee,Francis D. Pagani,Robert J. Gordon,Eduardo Rame,Michael A. Acker,Robert L. Kormos,Christopher T. Salerno,Thomas P. Schleeter,Daniel J. Goldstein,Julia Shin,Randall C. Starling,Thomas C. Wozniak,Adnan S. Malik,Scott C. Silvestry,Gregory A. Ewald,Ulrich P. Jorde,Yoshifumi Naka,Emma J. Birks,Kevin B. Najarian,David R. Hathaway,Keith D. Aaronson,Advance Trial Investigators +24 more
TL;DR: Anticoagulation, antiplatelet therapy, and blood pressure management affected the prevalence of cerebrovascular events after implantation of the HVAD.
Journal ArticleDOI
Risk factors, mortality, and timing of ischemic and hemorrhagic stroke with left ventricular assist devices.
Jennifer A. Frontera,Randall C. Starling,Sung Min Cho,Amy S. Nowacki,Ken Uchino,M. Shazam Hussain,Maria Mountis,Nader Moazami +7 more
TL;DR: Risk of stroke and death among patients with stroke is bimodal, with highest risk at time of implant and increasing risk again after 9-12 months later, and management of modifiable risk factors may reduce stroke and mortality rates.
Journal ArticleDOI
Left Ventricular Assist Device Infections: A Systematic Review.
John C. O’Horo,Omar Abu Saleh,John M. Stulak,Mark P. Wilhelm,Larry M. Baddour,M. Rizwan Sohail +5 more
TL;DR: A systematic review and meta-analysis of studies describing infections in continuous-flow LVADs found driveline infections were the most common infection reported and the easiest to treat with fewest long-term consequences.
Journal ArticleDOI
Stroke After Left Ventricular Assist Device Implantation: Outcomes in the Continuous-Flow Era
Laura Harvey,Christopher T. Holley,Samit S. Roy,Peter Eckman,Rebecca Cogswell,Kenneth Liao,Ranjit John +6 more
TL;DR: Stroke while on CF-LVAD support was associated with significant mortality and it is essential to further elucidate risk factors, to optimize anticoagulation, and to further understand the impact of LVAD-related infections.
References
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Journal ArticleDOI
CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting.
TL;DR: In this paper, the NHSN criteria for all healthcare-associated infections (HAIs) are presented, including those for the "Big Four" (surgical site infection [SSI], pneumonia [PNEU], bloodstream infection [BSI] and urinary tract infection [UTI]).
Journal Article
CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting.
TL;DR: In this article, the NHSN criteria for all healthcare-associated infections (HAIs) are presented, including those for the "Big Four" (surgical site infection [SSI], pneumonia [PNEU], bloodstream infection [BSI] and urinary tract infection [UTI]).
Journal ArticleDOI
Advanced Heart Failure Treated with Continuous-Flow Left Ventricular Assist Device
Mark S. Slaughter,Joseph G. Rogers,Carmelo A. Milano,Stuart D. Russell,John V. Conte,David S. Feldman,Benjamin Sun,Antone Tatooles,Reynolds M. Delgado,James W. Long,Thomas C. Wozniak,Waqas Ghumman,David J. Farrar,O. Howard Frazier +13 more
TL;DR: Treatment with a continuous-flow left ventricular assist device in patients with advanced heart failure significantly improved the probability of survival free from stroke and device failure at 2 years as compared with a pulsatile device.
Journal ArticleDOI
Use of a Continuous-Flow Device in Patients Awaiting Heart Transplantation
Leslie W. Miller,Leslie W. Miller,Francis D. Pagani,Stuart D. Russell,Ranjit John,Andrew J. Boyle,Keith D. Aaronson,John V. Conte,Yoshifumi Naka,Donna Mancini,Reynolds M. Delgado,Thomas E. MacGillivray,David J. Farrar,O.H. Frazier +13 more
TL;DR: A continuous-flow left ventricular assist device can provide effective hemodynamic support for a period of at least 6 months in patients awaiting heart transplantation, with improved functional status and quality of life.
Journal ArticleDOI
Clinical management of continuous-flow left ventricular assist devices in advanced heart failure
Mark S. Slaughter,Francis D. Pagani,Joseph G. Rogers,Leslie W. Miller,Benjamin Sun,Stuart D. Russell,Randall C. Starling,Leway Chen,Andrew J. Boyle,Suzanne Chillcott,Robert M. Adamson,Margaret S. Blood,Margarita Camacho,Katherine A. Idrissi,Michael Petty,Michael A. Sobieski,Susan Wright,Timothy J. Myers,David J. Farrar +18 more
TL;DR: Key elements in managing patients supported with the new continuous-flow LVADs are proposed, including implants techniques, troubleshooting device problems, and algorithms for outpatient management, including the diagnosis and treatment of related problems associated with the HeartMate II.
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