Is It Safe to Irradiate the Newest Generation of Ventricular Assist Devices? A Case Report and Systematic Literature Review.

An increasing number of mechanical assist devices, especially Left Ventricular Assist Devices (VAD), are being implanted for prolonged periods and as destination therapy. Some VAD patients require radiotherapy due to concomitant oncologic morbidities, including thoracic malignancies. This raises the potential of VAD malfunction via radiation-induced damage. So far, only case reports and small case series on radiotherapy have been published; most of them on HeartMate IITM (HMII, Abbott, North Chicago, IL, USA). Significantly, the effects of irradiation on the HeartMate 3TM (HM3, Abbott, North Chicago, IL, USA) remain undefined, despite the presence of controller components engineered within the pump itself. We report the first case of a patient with a HM3 who successfully underwent stereotactic hypo-fractionated radiotherapy due to an early stage non-small-cell lung cancer. The patient did not suffer from any complications; including toxicity or VAD malfunction. Based on this case report and on published literature, we think that performing radiotherapy after VAD implantation with the aid of a multidisciplinary team could be performed, but more in-vitro and cases series are needed to reinforce this statement

Communicative competence as a basis for the creative interaction of the professional (vocational-technical) education institution's subjects: the special course for the audience members of the advanced training classes of professional education administra

Матеріали спецкурсу присвячено проблемі комунікативної компетентності керівників, новопризначених керівників та педагогічних працівників обласних навчально-(науково)-методичних центрів (кабінетів), закладів професійної (професійно-технічної) освіти для удосконалення власного досвіду та педагогічної майстерності. Зміст спецкурсу спрямовано на розвиток комунікативної взаємодії суб’єктів освітнього процесу, професійно-особистісного розвитку педагогічних кадрів. Спецкурс підготовлений для слухачів курсів підвищення кваліфікації керівних та педагогічних кадрів професійної (професійно-технічної) освіти у Центральному інституті післядипломної освіти ДВНЗ «Університет менеджменту освіти».The materials of special course are devoted to the problem of communicative competence of managers, newly appointed managers and pedagogical workers of regional educational (scientific) -methodic centers (offices), institutions of professional (vocational-technical) education for improving their own experience and pedagogical skills. The content of the special course aims to develop the communicative interaction between the subjects of the educational process, professional and personal development of teaching staff. The special course has been developed for management and pedagogical staff of vocational (vocational-technical) education refresher training at the Central Institute of Postgraduate Education "University of Education Management"

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Major adverse kidney events predict reduced survival in ventricular assist device supported patients

Aims: There is limited data describing major adverse kidney events (MAKE) in patients supported with ventricular assistdevices (VAD). We aim to describe the association between MAKE and survival, risk factors for MAKE, and renal trajectoryin VAD supported patients. Methods and results: We conducted a single-centre retrospective analysis of consecutive VAD implants between 2010 and2019. Baseline demographics, biochemistry, and adverse events were collected for the duration of VAD support. MAKE wasdefined as thefirst event to occur of sustained drop (\u3e50%) in estimated glomerularfiltration rate (eGFR), progression tostage V chronic kidney disease, initiation or continuation of renal replacement therapy beyond implant admission or deathon renal replacement therapy at any time. One-hundred and seventy-three patients were included, median age 56.8 years,18.5% female, INTERMACS profile 1 or 2 in 75.1%. Thirty-seven patients experienced MAKE. On multivariate analysis,post-implant clinical right ventricular failure and the presence of chronic haemolysis, defined by the presence of schistocyteson bloodfilm analysis, were significantly associated with increased risk of MAKE (adjusted odds ratio 9.88,P\u3c0.001 andadjusted odds ratio 3.33,P= 0.006, respectively). MAKE was associated with reduced survival (hazard ratio 4.80,P\u3c0.001). Patients who died or experienced MAKE did not demonstrate the expected transient 3-month improvement ineGFR, seen in other cohorts. Conclusions: MAKE significantly impacts survival. In our cohort, MAKE was predicted by post-implant right ventricular failureand chronic haemolysis. The lack of early eGFR improvement on VAD support may indicate higher risk for MAKE

Right ventricular failure post LVAD implantation corrected with biventricular support : an in vitro model

Right ventricular failure after left ventricular assist device (LVAD) implantation is associated with high mortality. Management remains limited to pharmacologic therapy and temporary mechanical support. Delayed right ventricular assist device (RVAD) support after LVAD implantation is associated with poorer outcomes. With the advent of miniaturized, durable, continuous flow ventricular assist device systems, chronic RVAD and biventricular assist device (BiVAD) support has been used with some success. The purpose of this study was to assess combined BiVAD and LVAD with delayed RVAD support within a four-elemental mock circulatory loop (MCL) simulating the human cardiovascular system. Our hypothesis was that delayed continuous flow RVAD (RVAD) would produce similar hemodynamic and flow parameters to those of initial BiVAD support. Using the MCL, baseline biventricular heart failure with elevated right and left filling pressures with low cardiac output was simulated. The addition of LVAD within a biventricular configuration improved cardiac output somewhat, but was associated with persistent right heart failure with elevated right-sided filling pressures. The addition of an RVAD significantly improved LVAD outputs and returned filling pressures to normal throughout the circulation. In conclusion, RVAD support successfully restored hemodynamics and flow parameters of biventricular failure supported with isolated LVAD with persistent elevated right atrial pressure

Major adverse kidney events predict reduced survival in ventricular assist device supported patients

Abstract Aims There is limited data describing major adverse kidney events (MAKE) in patients supported with ventricular assist devices (VAD). We aim to describe the association between MAKE and survival, risk factors for MAKE, and renal trajectory in VAD supported patients. Methods and results We conducted a single‐centre retrospective analysis of consecutive VAD implants between 2010 and 2019. Baseline demographics, biochemistry, and adverse events were collected for the duration of VAD support. MAKE was defined as the first event to occur of sustained drop (>50%) in estimated glomerular filtration rate (eGFR), progression to stage V chronic kidney disease, initiation or continuation of renal replacement therapy beyond implant admission or death on renal replacement therapy at any time. One‐hundred and seventy‐three patients were included, median age 56.8 years, 18.5% female, INTERMACS profile 1 or 2 in 75.1%. Thirty‐seven patients experienced MAKE. On multivariate analysis, post‐implant clinical right ventricular failure and the presence of chronic haemolysis, defined by the presence of schistocytes on blood film analysis, were significantly associated with increased risk of MAKE (adjusted odds ratio 9.88, P < 0.001 and adjusted odds ratio 3.33, P = 0.006, respectively). MAKE was associated with reduced survival (hazard ratio 4.80, P < 0.001). Patients who died or experienced MAKE did not demonstrate the expected transient 3‐month improvement in eGFR, seen in other cohorts. Conclusions MAKE significantly impacts survival. In our cohort, MAKE was predicted by post‐implant right ventricular failure and chronic haemolysis. The lack of early eGFR improvement on VAD support may indicate higher risk for MAKE

Valvular regurgitation in a biventricular mock circulatory loop

Aortic regurgitation (AR), mitral regurgitation (MR), and tricuspid regurgitation (TR) after continuous-flow left ventricular assist device (LVAD) are common and may increase with prolonged LVAD support. The aim of this study was to simulate severe valvular regurgitation (AR, MR, and TR) within a 4-elemental pulsatile mock circulatory loop (MCL) and observe their impact on isolated LVAD and biventricular assist device (BiVAD) with HeartWare HVAD. Aortic regurgitation, MR, and TR were achieved via the removal of one leaflet from bileaflet mechanical valve from the appropriate valves of the left or right ventricles. The impact of alteration of LVAD pump speed (LVAD 2200-4000 RPM, right ventricular assist device [RVAD] 2400 RPM) and altered LVAD preload (10-25 mm Hg) was assessed. With each of the regurgitant valve lesions, there was a decrease in isolated LVAD pump flow pulsatility. Isolated LVAD provided sufficient support in the setting of severe MR or TR compared with control, and flows were enhanced with BiVAD support. In severe AR, there was no benefit of BiVAD support over isolated LVAD, and actual loop flows remained low. High LVAD flows combined with low RVAD flows and dampened aortic pressures are good indicators of AR. The 4-elemental MCL successfully simulated several control and abnormal valvular conditions using various pump speeds. Current findings are consistent with conservative management of MR and TR in the setting of mechanical support, but emphasize the importance of the correction of AR

Intermittent papillary muscle suction: A rare cause of left ventricular assist device low flow

Low flow alarms represent a management challenge in patients with left ventricular assist devices because they are often a consequence of complex patient-device interactions. We present a case of intermittent suction of the postero-medial papillary muscle into the left ventricular assist device inflow cannula during diastole, causing low flows. This case highlights the importance of a systematic approach and use of multiple investigation modalities in making an accurate diagnosis. (Level of Difficulty: Advanced.

Is it safe to irradiate the newest generation of ventricular assist devices? A case report and systematic literature review

An increasing number of mechanical assist devices, especially Left Ventricular Assist Devices (VAD), are being implanted for prolonged periods and as destination therapy. Some VAD patients require radiotherapy due to concomitant oncologic morbidities, including thoracic malignancies. This raises the potential of VAD malfunction via radiation-induced damage. So far, only case reports and small case series on radiotherapy have been published; most of them on HeartMate IITM (HMII, Abbott, North Chicago, IL, USA). Significantly, the effects of irradiation on the HeartMate 3TM (HM3, Abbott, North Chicago, IL, USA) remain undefined, despite the presence of controller components engineered within the pump itself. We report the first case of a patient with a HM3 who successfully underwent stereotactic hypo-fractionated radiotherapy due to an early stage non-small-cell lung cancer. The patient did not suffer from any complications; including toxicity or VAD malfunction. Based on this case report and on published literature, we think that performing radiotherapy after VAD implantation with the aid of a multidisciplinary team could be performed, but more in-vitro and cases series are needed to reinforce this statement