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      Editorial: Mechanical circulatory support therapy for biventricular failure


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          Global burden of heart failure: a comprehensive and updated review of epidemiology

          Heart Failure (HF) is a multi-faceted and life-threatening syndrome characterized by significant morbidity and mortality, poor functional capacity and quality of life, and high costs. HF affects more than 64 million people worldwide. Therefore, attempts to decrease its social and economic burden have become a major global public health priority. While the incidence of HF has stabilized and seems to be declining in industrialized countries, the prevalence is increasing due to the ageing of the population, improved treatment of and survival with ischaemic heart disease, and the availability of effective evidence-based therapies prolonging life in patients with HF. There are geographical variations in HF epidemiology. There is substantial lack of data from developing countries, where HF exhibits different features compared with that observed in the Western world. In this review, we provide a contemporary overview on the global burden of HF, providing updated estimates on prevalence, incidence, outcomes, and costs worldwide.
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            Left ventricular vs. biventricular mechanical support: Decision making and strategies for avoidance of right heart failure after left ventricular assist device implantation

            Left ventricular assist devices (LVADs) are safer and provide better survival and better quality of life than biventricular assist devices (BVADs) but end-stage heart failure often involves both ventricles, even if its initial cause was left-sided heart disease. Right ventricular failure (RVF) is also a severe complication in about 25% of patients receiving an LVAD, with high perioperative morbidity (renal, hepatic or multi-organ failure) and mortality. Patients who receive an RV assist device (RVAD) only days after LVAD insertion fare much worse than those who receive an RVAD simultaneously with LVAD implantation. Temporary RVAD support in LVAD recipients with high risk for postoperative RVF can avoid permanent BVAD support. Thus, patients who definitely need a BVAD should already be identified preoperatively or at least intra-operatively. However, although the initial biochemical, hemodynamic and echocardiographic patient profiles at admission may suggest the need for a BVAD, many risk factors may be favorably modified by various strategies that may result in avoidance of RVF after LVAD implantation. This article summarizes the knowledge of risk factors for irreversible RVF after LVAD implantation and strategies to optimize RV function (preoperatively, intra-operatively and post-operatively) aimed to reduce the number of BVAD implantations. Special attention is focused on assessment of RV size, geometry and function in relation to loading conditions with the goal of predicting preoperatively the RV changes which might be induced by RV afterload reduction with the LVAD. The review also provides a theoretical and practical basis for clinicians intending to be engaged in this field.
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              Temporary right ventricular mechanical support in high-risk left ventricular assist device recipients versus permanent biventricular or total artificial heart support.

              Early planned institution of temporary right ventricular assist device (RVAD) support with the CentriMag (Levitronix LLC, Waltham, MA, USA) in left ventricular assist device (LVAD) recipients was compared with permanent biventricular assist device (BVAD) or total artificial heart (TAH) support. Between 2007 and 2011, 77 patients (age range: 25-70 years) with preoperative evidence of biventricular dysfunction (University of Pennsylvania score >50; University of Michigan score >5) were included. Forty-six patients (38 men; median age 54.5 years, range: 25-70 years) underwent LVAD placement combined with temporary RVAD support (group A); in 31 patients (25 men; median age 56.7 years, range: 28-68 years), a permanent BVAD or TAH implantation (group B) was performed. Within 30 days, 12 patients from group A (26.08%) and 14 patients from group B (45.1%) died on mechanical support (P = 0.02). Thirty patients (65.2%) in group A were weaned from temporary RVAD support and three (6.5%) underwent permanent RVAD (HeartWare, Inc., Framingham, MA, USA) placement. A total of 26 patients (56.5%) were discharged home in group A versus 17 (54.8%) in group B (P = 0.56). Three patients (8.5%) received heart transplantation in group A and six (19.3%) in group B (P = 0.04). In group A, 90-day and 6-month survival was 54.3% (n = 25) versus 51.6% (n = 16) in group B (P = 0.66). In group A, 1-year survival was 45.6% (n = 21) versus 45.1% (n = 14) in group B (P = 0.81). The strategy of planned temporary RVAD support in LVAD recipients showed encouraging results if compared with those of a similar permanent BVAD/TAH population. Weaning from and removal of the temporary RVAD support may allow patients to be on LVAD support only despite preoperative biventricular dysfunction.

                Author and article information

                URI : https://loop.frontiersin.org/people/1562161/overviewRole: Role:
                URI : https://loop.frontiersin.org/people/1730977/overviewRole: Role:
                URI : https://loop.frontiersin.org/people/1750887/overviewRole: Role:
                Front Cardiovasc Med
                Front Cardiovasc Med
                Front. Cardiovasc. Med.
                Frontiers in Cardiovascular Medicine
                Frontiers Media S.A.
                22 May 2024
                : 11
                : 1421550
                [ 1 ]Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic , Cleveland, OH, United States
                [ 2 ]Department of Biomedical Engineering, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University , Cleveland, OH, United States
                [ 3 ]Kaufman Center for Heart Failure, Heart, Vascular, and Thoracic Institute, Cleveland Clinic , Cleveland, OH, United States
                [ 4 ]Ibaraki University , Mito, Japan
                Author notes

                Edited and Reviewed by: Michael Henein, Umeå University, Sweden

                [* ] Correspondence: Jamshid H. Karimov karimoj.cc@ 123456gmail.com
                © 2024 Karimov, Fukamachi and Masuzawa.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                : 22 April 2024
                : 14 May 2024
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 6, Pages: 0, Words: 0
                Cardiovascular Medicine
                Custom metadata
                Heart Failure and Transplantation

                heart failure,biventricular failure,mechanical circulatory support,bvad,device therapies


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