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2. Comprehensive effects of left ventricular assist device speed changes on alveolar gas exchange, sleep ventilatory pattern, and exercise performance

Author

Apostolo, A, Paolillo, S, Contini, M, Vignati, C, Tarzia, V, Campodonico, J, Mapelli, M, Massetti, M, Bejko, J, Righini, F, Bottio, T, Bonini, N, Salvioni, E, Gugliandolo, P, Parati, G, Lombardi, C, Gerosa, G, Salvi, L, Alamanni, F, Agostoni, P, Apostolo, Anna, Paolillo, Stefania, Contini, Mauro, Vignati, Carlo, Tarzia, Vincenzo, Campodonico, Jeness, Mapelli, Massimo, Massetti, Massimo, Bejko, Jonida, Righini, Francesca, Bottio, Tomaso, Bonini, Niccolò, Salvioni, Elisabetta, Gugliandolo, Paola, Parati, Gianfranco, Lombardi, Carolina, Gerosa, Gino, SALVI, LUCA, Alamanni, Francesco, Agostoni, Piergiuseppe, Apostolo, A, Paolillo, S, Contini, M, Vignati, C, Tarzia, V, Campodonico, J, Mapelli, M, Massetti, M, Bejko, J, Righini, F, Bottio, T, Bonini, N, Salvioni, E, Gugliandolo, P, Parati, G, Lombardi, C, Gerosa, G, Salvi, L, Alamanni, F, Agostoni, P, Apostolo, Anna, Paolillo, Stefania, Contini, Mauro, Vignati, Carlo, Tarzia, Vincenzo, Campodonico, Jeness, Mapelli, Massimo, Massetti, Massimo, Bejko, Jonida, Righini, Francesca, Bottio, Tomaso, Bonini, Niccolò, Salvioni, Elisabetta, Gugliandolo, Paola, Parati, Gianfranco, Lombardi, Carolina, Gerosa, Gino, SALVI, LUCA, Alamanni, Francesco, and Agostoni, Piergiuseppe

Abstract

Increasing left ventricular assist device (LVAD) pump speed according to the patient's activity is a fascinating hypothesis. This study analyzed the short-term effects of LVAD speed increase on cardiopulmonary exercise test (CPET) performance, muscle oxygenation (near-infrared spectroscopy), diffusion capacity of the lung for carbon monoxide (Dlco) and nitric oxide (Dlno), and sleep quality.

Published
2018

5. Sleep and Life Quality with Left Ventricle Assist Devices or Transplanted Heart: Results from a Multi-Center Observational Study

Author

Bottio, T., primary, Bejko, J., additional, Ocagli, H., additional, Carrozzini, M., additional, Pagnin, C., additional, Tarzia, V., additional, Agostoni, P., additional, Bacich, D., additional, Ortis, H., additional, Livi, U., additional, Maiani, M., additional, Apostolo, A., additional, Di Gianmarco, G., additional, Lanera, C., additional, Gregori, D., additional, and Gerosa, G., additional

Published
2018
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10. Technology and Techniques: Tools to Mitigate Adverse Events and Improve Survival in Left Ventricular Assist Device Patients

Author

Tarzia, V., primary, Di Giammarco, G., additional, Maccherini, M., additional, Maiani, M., additional, Agostoni, P., additional, Bagozzi, L., additional, Marinelli, D., additional, Tursi, V., additional, Apostolo, A., additional, Bernazzali, S., additional, Bejko, J., additional, Ortis, H., additional, Di Mauro, M., additional, Dokollari, A., additional, Bortolussi, G., additional, Alamanni, F., additional, Sani, G., additional, Bottio, T., additional, Livi, U., additional, and Gerosa, G., additional

Published
2017
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12. Hemorrhage and thrombosis with different LVAD technologies: a matter of flow?

Author

Tarzia, V, Buratto, E, Bortolussi, G, Gallo, M, Bejko, J, Bianco, R, Bottio, Tomaso, and Gerosa, Gino

Subjects
Featured Article
Abstract

Much of the morbidity and mortality associated with ventricular assist devices (VADs) is due to haemorrhagic and thrombotic complications. To manage antithrombotic therapy, interactions between the patient and pump should be better understood.We have compared the Jarvik 2000, an axial flow left ventricular assist device (LVAD), with the HeartWare ventricular assist device (HVAD) centrifugal pump, regarding conventional laboratory findings, thromboelastometric and aggregometric tests.Patients with the Jarvik 2000 experienced a significant reduction in platelet count following implantation, a phenomenon not seen with the HeartWare model. Conversely, we observed that levels of platelet activation, as assessed by a platelet function analyzer, and activation of the coagulation system, as assessed by thromboelastometry, were significantly greater in the HeartWare group.It seems that axial flow pumps, being more destructive on blood cells, tend to reduce platelet numbers. On the other hand, centrifugal flow is associated with a hypercoagulable state, possibly resulting from the activation of the coagulation system in the absence of platelet destruction.

Published
2014

14. The danger of using a sledgehammer to crack a nut: ROTEM-guided administration of recombinant activated factor VII in a patient with refractory bleeding post-ventricular assist device implantation

Author

Tarzia, V, Buratto, E, Bortolussi, G, Paolini, C, Bejko, J, Bottio, Tomaso, and Gerosa, Gino

Subjects
Male, Dose-Response Relationship, Drug, Shock, Cardiogenic, Thrombosis, Factor VIIa, Middle Aged, Postoperative Hemorrhage, Risk Assessment, Severity of Illness Index, Drug Administration Schedule, Hemostatics, Recombinant Proteins, Thrombelastography, Myocarditis, Treatment Outcome, Recurrence, Humans, Heart-Assist Devices, Infusions, Intravenous, Follow-Up Studies
Abstract

Recombinant activated factor VII (rFVIIa) is currently approved for treating or preventing hemorrhage in patients with hemophilia, Glanzmann's thrombasthenia, or congenital FVII deficiency. Its "off-label" use for massive bleeding in the setting of trauma or surgery has been increasing because of demonstrated efficacy. However, the use of rFVIIa also carries a high thrombo-embolic risk. This is particularly true in cardiac surgery patients, especially those treated with mechanical circulatory support. We describe the case of a patient treated with a biventricular assist device in our center, in whom severe bleeding was treated in a targeted manner, using rotational thromboelastometry to guide administration and dosing of rFVIIa. A comprehensive review of the emerging literature on the use of rFVIIa postventricular assist device implantation accompanies the case to highlight the need for careful selection of prohemostatic agents in this high-risk group.

Published
2014

17. Access Matters: Survival Advantage with Minimally Invasive Implantation of LVAD as Destination Therapy

Author

Tarzia, V., primary, Di Mauro, M., additional, Bortolussi, G., additional, Bejko, J., additional, Marinelli, D., additional, Foschi, M., additional, Maccherini, M., additional, Bernazzali, S., additional, Maiani, M., additional, Tursi, V., additional, Agostoni, P., additional, Apostolo, A., additional, Alamanni, F., additional, Livi, U., additional, Sani, G., additional, Bottio, T., additional, Di Giammarco, G., additional, and Gerosa, G., additional

Published
2016
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38. Different Impact on the Coagulation System of Two Continuous Flow LVADs: Axial Versus Centrifugal Flow

Author

Tarzia, V., primary, Vasques, F., additional, Bortolussi, G., additional, Bejko, J., additional, Gallo, M., additional, Carrozzini, M., additional, Comisso, M., additional, Buratto, E., additional, De Franceschi, M., additional, Campello, E., additional, Spiezia, L., additional, Simioni, P., additional, Bottio, T., additional, and Gerosa, G., additional

Published
2013
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48. Comprehensive effects of left ventricular assist device speed changes on alveolar gas exchange, sleep ventilatory pattern, and exercise performance

Author

Jonida Bejko, Jeness Campodonico, Vincenzo Tarzia, Niccolò Bonini, Anna Apostolo, Stefania Paolillo, Francesca Maria Righini, Luca Salvi, Gianfranco Parati, Francesco Alamanni, Tomaso Bottio, Carolina Lombardi, Massimo Mapelli, Piergiuseppe Agostoni, Paola Gugliandolo, Elisabetta Salvioni, Carlo Vignati, Massimo Massetti, Mauro Contini, Gino Gerosa, Apostolo, A., Paolillo, S., Contini, M., Vignati, C., Tarzia, V., Campodonico, J., Mapelli, M., Massetti, M., Bejko, J., Righini, F., Bottio, T., Bonini, N., Salvioni, E., Gugliandolo, P., Parati, G., Lombardi, C., Gerosa, G., Salvi, L., Alamanni, F., Agostoni, P., Apostolo, A, Paolillo, S, Contini, M, Vignati, C, Tarzia, V, Campodonico, J, Mapelli, M, Massetti, M, Bejko, J, Righini, F, Bottio, T, Bonini, N, Salvioni, E, Gugliandolo, P, Parati, G, Lombardi, C, Gerosa, G, Salvi, L, Alamanni, F, and Agostoni, P

Subjects
Pulmonary and Respiratory Medicine, Spirometry, Male, medicine.medical_specialty, Cardiac output, LVAD, cardiac output, CPET, exercise, lung diffusion, muscle oxygenation, Surgery, Cardiology and Cardiovascular Medicine, Transplantation, Cardiac index, 030204 cardiovascular system & hematology, Nitric Oxide, 03 medical and health sciences, 0302 clinical medicine, Oxygen Consumption, Internal medicine, medicine, Humans, Muscle, Skeletal, Aged, Heart Failure, Carbon Monoxide, medicine.diagnostic_test, business.industry, Pulmonary Gas Exchange, Apnea, Gas exchange, Oxygenation, Equipment Design, Middle Aged, medicine.disease, 030228 respiratory system, Apnea–hypopnea index, Cardiology, Pulmonary Diffusing Capacity, Female, Heart-Assist Devices, medicine.symptom, business, Sleep, Hypopnea, Human
Abstract

BACKGROUND Increasing left ventricular assist device (LVAD) pump speed according to the patient's activity is a fascinating hypothesis. This study analyzed the short-term effects of LVAD speed increase on cardiopulmonary exercise test (CPET) performance, muscle oxygenation (near-infrared spectroscopy), diffusion capacity of the lung for carbon monoxide (D lco ) and nitric oxide (D lno ), and sleep quality. METHODS We analyzed CPET, D lco and D lno , and sleep in 33 patients supported with the Jarvik 2000 (Jarvik Heart Inc., New York, NY). After a maximal CPET (n = 28), patients underwent 2 maximal CPETs with LVAD speed randomly set at 3 or increased from 3 to 5 during effort (n = 15). Then, at LVAD speed randomly set at 2 or 4, we performed (1) constant workload CPETs assessing O2 kinetics, cardiac output (CO), and muscle oxygenation (n = 15); (2) resting D lco and D lno (n = 18); and (3) nocturnal cardiorespiratory monitoring ( n = 29). RESULTS The progressive pump speed increase raised peak volume of oxygen consumption (12.5 ± 2.5 ml/min/kg vs 11.7 ± 2.8 ml/min/kg at speed 3; p = 0.001). During constant workload, from speed 2 to 4, CO increased (at rest: 3.18 ± 0.76 liters/min vs 3.69 ± 0.75 liters/min, p = 0.015; during exercise: 5.91 ± 1.31 liters/min vs 6.69 ± 0.99 liters/min, p = 0.014), and system efficiency (τ = 65.8 ± 15.1 seconds vs 49.9 ± 14.8 seconds, p = 0.002) and muscle oxygenation improved. At speed 4, D lco decreased, and obstructive apneas increased despite a significant apnea/hypopnea index and a reduction of central apneas. CONCLUSIONS Short-term LVAD speed increase improves exercise performance, CO, O2 kinetics, and muscle oxygenation. However, it deteriorates lung diffusion and increases obstructive apneas, likely due to an increase of intrathoracic fluids . Self-adjusting LVAD speed is a fascinating but possibly unsafe option, probably requiring a monitoring of intrathoracic fluids.

Published
2018

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