Attisani, M.

Donker, Dirk W.

Gummert, J.

Haneya, A.

Jawa, K.

Jorde, U.

Laforte, A.

Morshuis, M.

Pappalardo, F.

Potapov, E.

Ramjankhan, F.

Riebandt, J.

Rinaldi, M.

Saeed, D.

Schibilsky, D.

Stein, J.

Tsyganenko, D.

Wieloch, R.

Zimpfer, D.

English

University of Twente Research Information

S78 The Journal of Heart and Lung Transplantation, Vol 40, No 4S, April 2021(Continued)Total number of patients 85Chronic HP 1 (1.2%)Bronchiectasis 1 (1.2%)RA ILD 1 (1.2%)Type of transplantBilateral 78 (92%)Single 7 (8%)CMV StatusD+/R+ 40 (47%)D+/R- 19 (22%)D-/R+ 15 (18%)D-/R- 11 (13%)EBV StatusD+/R+ 79 (93%)D-/R+ 6 (7%)GFR calculated by CKD EPI right before Belatacept initiation 43 IQR (36-50)CKD Stage at Belatacept initiationStage 1 GFR >90 3 (3.5%)Stage 2 GFR 89-60 6 (7%)Stage 3a GFR 59-45 28 (33%)Stage 3b GFR 44-30 37 (43.5%)Stage 4 GFR 29-15 10 (12%)Stage 5 GFR <15 1 (1.17%)Infections beforeBelataceptInfections afterBelatacept initiationAspergillus 4 (4.7%) 6 (7%)CMV reactivation 22 (26%) 32 (37.6%)NTM 7 (8.2%) 3 (3.5%)Malignancybefore BelataceptMalignancy afterBelatacept initiationSquamous cell cancer of the skin 6 (7%) 9 (10.5%)Basal cell cancer of the skin 2 (2.4%) 1 (1.2%)PTLD 0 1 (1.2%)MDS 0 1 (1.2%)Papillary squamous cell cancer of larynx 0 1 (1.2%)Melanoma in situ 0 1 (1.2%)Gastric adenocarcinoma 0 1 (1.2%)(167)Neurological Complications in Patients Requiring Durable VADSystems after ECLS Support. On Behalf of ECLS- Durable MCS StudyGroupD. Saeed,1 E. Potapov,2 A. Loforte,3 M. Morshuis,4 D. Schibilsky,5 D.Zimpfer,6 J. Riebandt,6 F. Pappalardo,7 M. Attisani,8 M. Rinaldi,8 A.Haneya,9 F. Ramjankhan,10 D. Donker,10 U. Jorde,11 J. Stein,2 D.Tsyganenko,2 K. Jawad,1 R. Wieloch,12 R. Ayala,5 J. Cremer,9 M.Borger,1 A. Lichtenberg,12 and J. Gummert.13 1Leipzig Heart Center,Leipzig, Germany; 2German Heart Center Berlin, Berlin, Germany;3Bologna University, Bologna, Italy; 4Heart and Diabetes Center NRW,Bad Oeynhausen, Germany; 5Freiburg University, Freiburg, Germany;6Medical University Vienna, Vienna, Austria; 7San Raffaele Hospital,Milan, Italy; 8University of Turin, Turin, Italy; 9University HospitalSchleswig Holstein, Kiel, Germany; 10University Medical Center Utrecht,Utrecht, Netherlands; 11Montefiore Medical Center, Newyork, NY;12Duesseldorf University Hospital, Dusseldorf, Germany; and the 13Heartand diabetes center NRW, Bad Oeynhausen, Germany.Purpose: Neurological complications are considered as most frequentcomplications following left ventricular device device (VAD) implanta-tion. The aim of this multicenter study is to investigate neurological com-plications in patients requiring durable VADs following extra-corporeallife support (ECLS) implantation.Methods: Data of eleven high volume ECLS/VAD centers are collectedand evaluated to identify patients who underwent durable mechanical cir-culatory support system implantation after ECLS systems between January2010 and July 2018. Preoperative parameters and postoperative outcomeare analysed. Data of patients who developed postoperative neurologicalcomplication will be analysed and compared.A total of 531 patients meets the inclusion criteria. Patients who were sup-ported with pulsatile pumps, CardioWest TAH and DeBakey VADs willbe excluded. The outcome of the remaining 501 patients (mean age 53 §2yo, 82% male, average ECLS support duration of 7 § 7 days and averageMELD score of 19 § 8), who were supported with either HeartWareHVAD, HeartMate II or HeartMate III pumps will be analysed.Endpoints: The primary endpoint will be freedom from stroke at 30, 180,and 360 days post implant. Association of stroke events with operativestrategies (using heart lung machine vs. ECLS for VAD implantation) willbe evaluated. Further, factors predicting stroke events in this patient popu-lation are analyzed. We hypothesize that postoperative (after VAD Implan-tation) stroke complications may be higher in this sick patient populationon ECLS compared to traditional VAD candidates.(168)The ABC’s of Stroke Prevention: Reduction in Stroke FrequencyFollowing a Quality Improvement Intervention by the Action LearningNetworkJ. Murray,1 D. Rosenthal,2 F. Zafar,3 A. Lorts,4 C. Connelly,5 P.Krack,4 C. Vanderpluym,6 B. Hawkins,6 R. Niebler,7 M. Mehegan,8 R.Gajarski,9 D. Sutcliffe,10 and C. Villa.4 1Lucile Packard Children'sHospital, Palo Alto, CA; 2Stanford University, Palo Alto, CA; 3CincinnatiChildren's Hospital, Cincinnati, CA; 4Cincinnati Children's Hospital,Cincinnati, OH; 5Cincinnati Children's Hospital, Cinncinati, OH; 6BostonChildren's Hospital, Boston, MA; 7Children's Hospital of Wisconsin,Milwaukee, WI; 8St. Louis Children's Hospital, St. Louis, MO; 9NationwideChildren's Hospital, Columbus, OH; and the 10UT Southwestern, Dallas,TX.Purpose: To assess the frequency of stroke among ventricular assistdevice patients following a quality improvement bundled intervention(the “ABCs of Stroke Prevention” [ABCs] which focused on Anticoa-gulation, Blood pressure, and Communication) within the AdvancedCardiac Therapies Improving Outcomes Network (ACTION). Thebundle intervention comprised 3 interventions. These were: a docu-ment harmonizing how to implement and maintain bivalirudin infu-sion, a blood pressure management protocol and a daily strokeprevention checklist.Methods: Baseline stroke outcomes prior to the formation of ACTION (Q32014 - Q2 2017) were obtained from Pediatric Interagency Registry forMechanical Circulatory Support (Pedimacs). The CVA adverse event defi-nition was used to assess stroke from Pedimacs. Stroke outcomes follow-ing implementation of the ABCs were obtained from the ACTIONOutcome Registry Q1 2018-9/18/2020.Results: A total of 693 patients (350 Pedimacs, 343 ACTION) and 887devices (472 Pedimacs, 415 ACTION) were included. The overall strokerate decreased following implementation of the ABCs from 14.6% to10.4% (p=0.03) (Figure 1). The paracorporeal pulsatile pump stroke ratedecreased from 30.1% to 8.2% (p<0.001) (Figure 2).

Neurological Complications in Patients Requiring Durable VAD Systems after ECLS Support. On Behalf of ECLS- Durable MCS Study Group

https://doi.org/10.1016/j.healun.2021.01.1931

Neurological Complications in Patients Requiring Durable VAD Systems after ECLS Support. On Behalf of ECLS- Durable MCS Study Group

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