The power words

Dr. O.P. Yadava, CEO and Chief Cardiac Surgeon, National Heart Institute, New Delhi, India, and Editor-in-Chief, Indian Journal of Thoracic and Cardiovascular Surgery, in conversation with Dr. Vivek Rao, Chief of Cardiovascular Surgery, Peter Munk Cardiac Centre, University of Toronto, discusses donation after circulatory death, role of pulsatility in mechanical circulatory support (MCS) and current status of MCS versus heart transplant as a destination therapy.Dr. O.P. Yadava, CEO and Chief Cardiac Surgeon, National Heart Institute, New Delhi, India, and Editor-in-Chief, Indian Journal of Thoracic and Cardiovascular Surgery, in a conversation with Dr. Catherine Dushyant Sudarshan, discusses the state of donation after circulatory death for cardiac transplant and how it can address the donor shortages.Advanced Heart Failure is one of the leading causes of death and hospitalization worldwide. Its incidence is increasing steadily in India as well. Despite a huge need, not many cardiologists take heart failure as a career option. The present article seeks to explore the potential reasons for this lack of interest among cardiologists of the country. It also briefly attempts to suggest remedial actions.Multimodality therapies have improved the survival after tumors like Ewing's sarcoma and breast cancer. However, cardiotoxicity following chemotherapy remains an important concern. We report a case series of four patients who presented to our heart team with severe dilated cardiomyopathy along with biventricular involvement. Two of the patients were females and had breast cancer for which they were treated with trastuzumab and had developed chemotherapy induced cardiomyopathy (CCMP). The other two patients were males who had Ewing's sarcoma who developed CCMP following treatment with doxorubicin.Despite the introduction of mechanical circulatory assist systems in India two decades ago, there has not been their wide usage due to two main reasons (1) economic-financial unaffordability and (2) lack of social support. There have been a number of significant steps taken by the government and by the media for augmenting awareness for organ donation. A sizeable donor pool in India falls into the category of marginal donors, due to a variety of reasons like geographical distances, lack of rapid transport, suboptimal donor management due to the lack of resources, and trained manpower in hospitals where donor harvest is done. Consequently, the usage of the heart as a donor organ is less than 20% in India. There is a lack of statistical data regarding the usage of heterotopic heart transplants, due to the absence of a registry, since the procedure is rarely performed, and comparative results are difficult to obtain due to different subsets of both donors and the recipients. The original papers by Barnard and Cooper cannot be extrapolated in the modern context, as these publications were in the pre-cyclosporin era. Orthotopic heart transplantation (OHT) is a well-established and commonly utilized procedure for patients with end-stage heart failure. Heterotopic heart transplantation (HHT) is a surgical procedure that allows the graft to be connected to the native heart in a parallel fashion to provide a kind of biological biventricular or univentricular (left ventricular support). It was performed first in human beings by Barnard in 1974 [S, J., 49, Afr, Med, 1975, 303-12].As the incidence of heart failure increases, an organ shortage for cardiac transplant worsens. There has been development of both short and long-term mechanical circulatory devices for this population, each with unique advantages and different adverse event profiles. The long-term devices provide excellent mechanical circulatory support but are associated with significant morbidity. The intravascular ventricular assist system (iVAS) is a minimally invasive, ambulatory, counterpulsation heart assist system developed to provide long-term support for patients with advanced heart failure while avoiding the surgical trauma of a left ventricular assist device and minimizing the risks of infection and hemocompatibility-related adverse events. Initial experience with the iVAS shows promising evidence for its use as a long-term mechanical circulatory support device.The increasing incidence of advanced heart failure and severe donor organ shortage for cardiac transplant has led to the development of implantable left ventricular assist devices (LVAD) for long-term mechanical circulatory support. There has been tremendous improvement in the device technology of LVADs, and there are a number of devices in use throughout the world. This article reviews the evidence behind each device and their unique features that can help when choosing a durable LVAD for an individual patient.
Ventricular assist devices (VADs) have provided a temporising solution to many individuals with refractory heart failure (HF) while awaiting a suitable donor for heart transplantation which remains the gold standard in treatment. Many of the discussions around VADs involve ongoing morbidity; however, one aspect of VADs that is often overlooked is the utility of their log files. We decided to review the literature for mentions of the clinical utility of VAD log files.
A keyword search was utilised on PUBMED using the terms 'Ventricular Assist Device' and 'Log files'. Perhaps unsurprisingly, this search only yielded 4 results with further articles being discovered through the bibliography of these publications.
The 4 identified articles provided basic information on log files, particularly with reference to the HVAD. Logs can be categorised into three types-data (pump parameters), events (changes in parameters) and alarms (abnormal function). Using a combination of these logs, we can readily identify abnog files is sparse with much untapped potential.The concept of a mechanical device to support failing hearts arose after the introduction of the heart lung bypass machine pioneered by Gibbon. The initial devices were the pulsatile paracorporeal and total artificial heart (TAH), driven by noisy chugging pneumatic pumps. Further development moved in three directions, namely short-term paracorporeal devices, left ventricular assist devices (LVADs), and TAH. selleck compound The paracorporeal pumps moved in the direction of electrically driven continuous-flow pumps as well as catheter-mounted intracardiac pumps for short-term use. The LVAD became the silent durable electric, implantable continuous-flow pumps. The TAH remains a pneumatically driven pulsatile device with limited application, but newer technology is moving toward electrically operated TAH. The most successful pumps are the durable implantable continuous-flow pumps now taken over by the 3rd-generation pumps for the bridge to transplant and long-term use with significantly improved survival and quality of life. But bleeding including gastrointestinal bleeding, strokes, and percutaneous driveline infections exist as troublesome issues.