Subjects -> MEDICAL SCIENCES (Total: 8819 journals)
    - ALLERGOLOGY AND IMMUNOLOGY (225 journals)
    - ANAESTHESIOLOGY (122 journals)
    - CARDIOVASCULAR DISEASES (352 journals)
    - CHIROPRACTIC, HOMEOPATHY, OSTEOPATHY (21 journals)
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    - UROLOGY, NEPHROLOGY AND ANDROLOGY (159 journals)

CARDIOVASCULAR DISEASES (352 journals)                  1 2 | Last

Showing 1 - 200 of 352 Journals sorted alphabetically
Acta Angiologica     Open Access   (Followers: 5)
Acta Cardiologica     Hybrid Journal   (Followers: 2)
Acute Cardiac Care     Hybrid Journal   (Followers: 11)
Adipositas - Ursachen, Folgeerkrankungen, Therapie     Hybrid Journal   (Followers: 1)
AJP Heart and Circulatory Physiology     Hybrid Journal   (Followers: 13)
Aktuelle Kardiologie     Hybrid Journal   (Followers: 2)
American Heart Journal     Hybrid Journal   (Followers: 64)
American Journal of Cardiology     Hybrid Journal   (Followers: 74)
American Journal of Cardiovascular Drugs     Hybrid Journal   (Followers: 22)
American Journal of Hypertension     Hybrid Journal   (Followers: 31)
American Journal of Preventive Cardiology     Open Access   (Followers: 3)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anatolian Journal of Cardiology     Open Access   (Followers: 6)
Angiología     Full-text available via subscription  
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1)
Angiology     Hybrid Journal   (Followers: 5)
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (Followers: 1)
Annals of Circulation     Open Access   (Followers: 2)
Annals of Noninvasive Electrocardiology     Hybrid Journal   (Followers: 1)
Annals of Pediatric Cardiology     Open Access   (Followers: 14)
AORTA     Open Access   (Followers: 1)
Archives of Cardiovascular Diseases     Full-text available via subscription   (Followers: 6)
Archives of Cardiovascular Diseases Supplements     Full-text available via subscription   (Followers: 4)
Archives of Cardiovascular Imaging     Open Access   (Followers: 2)
Archivos de cardiología de México     Open Access   (Followers: 2)
Argentine Journal of Cardiology (English edition)     Open Access   (Followers: 3)
Arquivos Brasileiros de Cardiologia     Open Access   (Followers: 2)
Arrhythmia & Electrophysiology Review     Open Access  
Arteriosclerosis, Thrombosis and Vascular Biology     Full-text available via subscription   (Followers: 34)
Artery Research     Hybrid Journal   (Followers: 5)
ARYA Atherosclerosis     Open Access  
ASAIO Journal     Hybrid Journal   (Followers: 3)
ASEAN Heart Journal     Open Access   (Followers: 3)
Asian Cardiovascular and Thoracic Annals     Hybrid Journal   (Followers: 2)
Aswan Heart Centre Science & Practice Services     Open Access   (Followers: 1)
Atherosclerosis : X     Open Access  
Bangladesh Heart Journal     Open Access   (Followers: 3)
Basic Research in Cardiology     Hybrid Journal   (Followers: 10)
BMC Cardiovascular Disorders     Open Access   (Followers: 25)
Brain Circulation     Open Access   (Followers: 1)
British Journal of Cardiology     Full-text available via subscription   (Followers: 18)
Canadian Journal of Cardiology     Hybrid Journal   (Followers: 17)
Cardiac Cath Lab Director     Full-text available via subscription   (Followers: 1)
Cardiac Electrophysiology Review     Hybrid Journal   (Followers: 3)
Cardiac Failure Review     Open Access   (Followers: 3)
Cardiocore     Full-text available via subscription   (Followers: 1)
Cardiogenetics     Open Access   (Followers: 4)
Cardiology     Full-text available via subscription   (Followers: 20)
Cardiology and Angiology: An International Journal     Open Access   (Followers: 1)
Cardiology and Therapy     Open Access   (Followers: 12)
Cardiology Clinics     Full-text available via subscription   (Followers: 14)
Cardiology in Review     Hybrid Journal   (Followers: 9)
Cardiology in the Young     Hybrid Journal   (Followers: 35)
Cardiology Journal     Open Access   (Followers: 6)
Cardiology Plus     Open Access   (Followers: 1)
Cardiology Research     Open Access   (Followers: 16)
Cardiology Research and Practice     Open Access   (Followers: 11)
Cardiopulmonary Physical Therapy Journal     Hybrid Journal   (Followers: 12)
Cardiorenal Medicine     Full-text available via subscription   (Followers: 1)
Cardiothoracic Surgeon     Open Access   (Followers: 1)
CardioVasc     Full-text available via subscription   (Followers: 1)
Cardiovascular & Haematological Disorders - Drug Targets     Hybrid Journal   (Followers: 2)
Cardiovascular & Hematological Agents in Medicinal Chemistry     Hybrid Journal   (Followers: 1)
CardioVascular and Interventional Radiology     Hybrid Journal   (Followers: 15)
Cardiovascular and Thoracic Open     Open Access  
Cardiovascular Diabetology     Open Access   (Followers: 10)
Cardiovascular Drugs and Therapy     Hybrid Journal   (Followers: 16)
Cardiovascular Endocrinology & Metabolism     Hybrid Journal   (Followers: 1)
Cardiovascular Engineering     Hybrid Journal   (Followers: 2)
Cardiovascular Engineering and Technology     Hybrid Journal   (Followers: 2)
Cardiovascular Intervention and Therapeutics     Hybrid Journal   (Followers: 6)
Cardiovascular Journal     Open Access   (Followers: 7)
Cardiovascular Journal of Africa     Full-text available via subscription   (Followers: 5)
Cardiovascular Journal of South Africa     Full-text available via subscription   (Followers: 2)
Cardiovascular Medicine in General Practice     Full-text available via subscription   (Followers: 7)
Cardiovascular Pathology     Hybrid Journal   (Followers: 4)
Cardiovascular Regenerative Medicine     Open Access  
Cardiovascular Research     Hybrid Journal   (Followers: 19)
Cardiovascular Revascularization Medicine     Hybrid Journal   (Followers: 1)
Cardiovascular System     Open Access  
Cardiovascular Therapeutics     Open Access   (Followers: 2)
Cardiovascular Toxicology     Hybrid Journal   (Followers: 8)
Cardiovascular Ultrasound     Open Access   (Followers: 5)
CASE : Cardiovascular Imaging Case Reports     Open Access  
Case Reports in Cardiology     Open Access   (Followers: 8)
Catheterization and Cardiovascular Interventions     Hybrid Journal   (Followers: 5)
Cerebrovascular Diseases     Full-text available via subscription   (Followers: 3)
Cerebrovascular Diseases Extra     Open Access  
Chest     Full-text available via subscription   (Followers: 114)
Choroby Serca i Naczyń     Open Access   (Followers: 1)
Circulation     Hybrid Journal   (Followers: 292)
Circulation : Cardiovascular Imaging     Hybrid Journal   (Followers: 18)
Circulation : Cardiovascular Interventions     Hybrid Journal   (Followers: 23)
Circulation : Cardiovascular Quality and Outcomes     Hybrid Journal   (Followers: 15)
Circulation : Genomic and Precision Medicine     Hybrid Journal   (Followers: 17)
Circulation : Heart Failure     Hybrid Journal   (Followers: 33)
Circulation Research     Hybrid Journal   (Followers: 37)
Cirugía Cardiovascular     Open Access  
CJC Open     Open Access   (Followers: 1)
Clínica e Investigación en Arteriosclerosis     Hybrid Journal  
Clínica e Investigación en arteriosclerosis (English Edition)     Hybrid Journal  
Clinical and Experimental Hypertension     Hybrid Journal   (Followers: 3)
Clinical Cardiology     Hybrid Journal   (Followers: 10)
Clinical Hypertension     Open Access   (Followers: 5)
Clinical Medicine Insights : Cardiology     Open Access   (Followers: 7)
Clinical Medicine Reviews in Cardiology     Hybrid Journal   (Followers: 1)
Clinical Research in Cardiology     Hybrid Journal   (Followers: 5)
Clinical Research in Cardiology Supplements     Hybrid Journal  
Clinical Trials and Regulatory Science in Cardiology     Open Access   (Followers: 4)
Congenital Heart Disease     Hybrid Journal   (Followers: 7)
Congestive Heart Failure     Hybrid Journal   (Followers: 4)
Cor et Vasa     Full-text available via subscription   (Followers: 2)
Coronary Artery Disease     Hybrid Journal   (Followers: 2)
CorSalud     Open Access  
Critical Pathways in Cardiology     Hybrid Journal   (Followers: 4)
Current Cardiology Reports     Hybrid Journal   (Followers: 6)
Current Cardiology Reviews     Hybrid Journal   (Followers: 3)
Current Cardiovascular Imaging Reports     Hybrid Journal   (Followers: 1)
Current Cardiovascular Risk Reports     Hybrid Journal  
Current Heart Failure Reports     Hybrid Journal   (Followers: 5)
Current Hypertension Reports     Hybrid Journal   (Followers: 6)
Current Hypertension Reviews     Hybrid Journal   (Followers: 6)
Current Opinion in Cardiology     Hybrid Journal   (Followers: 13)
Current Problems in Cardiology     Hybrid Journal   (Followers: 3)
Current Research : Cardiology     Full-text available via subscription   (Followers: 1)
Current Treatment Options in Cardiovascular Medicine     Hybrid Journal   (Followers: 3)
Current Vascular Pharmacology     Hybrid Journal   (Followers: 5)
CVIR Endovascular     Open Access   (Followers: 1)
Der Kardiologe     Hybrid Journal   (Followers: 1)
Echo Research and Practice     Open Access   (Followers: 2)
Echocardiography     Hybrid Journal   (Followers: 4)
Egyptian Heart Journal     Open Access   (Followers: 2)
Egyptian Journal of Cardiothoracic Anesthesia     Open Access  
ESC Heart Failure     Open Access   (Followers: 5)
European Cardiology Review     Open Access   (Followers: 1)
European Heart Journal     Hybrid Journal   (Followers: 77)
European Heart Journal - Cardiovascular Imaging     Hybrid Journal   (Followers: 11)
European Heart Journal - Cardiovascular Pharmacotherapy     Full-text available via subscription   (Followers: 3)
European Heart Journal - Quality of Care and Clinical Outcomes     Hybrid Journal   (Followers: 1)
European Heart Journal : Acute Cardiovascular Care     Hybrid Journal   (Followers: 1)
European Heart Journal : Case Reports     Open Access   (Followers: 2)
European Heart Journal Supplements     Hybrid Journal   (Followers: 7)
European Journal of Cardio-Thoracic Surgery     Hybrid Journal   (Followers: 10)
European Journal of Cardio-Thoracic Surgery Supplements     Full-text available via subscription   (Followers: 2)
European Journal of Cardiovascular Nursing     Hybrid Journal   (Followers: 5)
European Journal of Heart Failure     Hybrid Journal   (Followers: 15)
European Journal of Preventive Cardiology.     Hybrid Journal   (Followers: 6)
European Stroke Organisation     Hybrid Journal   (Followers: 7)
Experimental & Translational Stroke Medicine     Open Access   (Followers: 10)
Expert Review of Cardiovascular Therapy     Full-text available via subscription   (Followers: 4)
Folia Cardiologica     Open Access  
Forum Zaburzeń Metabolicznych     Hybrid Journal  
Frontiers in Cardiovascular Medicine     Open Access   (Followers: 1)
Future Cardiology     Hybrid Journal   (Followers: 5)
General Thoracic and Cardiovascular Surgery     Hybrid Journal   (Followers: 4)
Global Cardiology Science and Practice     Open Access   (Followers: 5)
Global Heart     Hybrid Journal   (Followers: 3)
Heart     Hybrid Journal   (Followers: 53)
Heart and Mind     Open Access  
Heart and Vessels     Hybrid Journal  
Heart Failure Clinics     Full-text available via subscription   (Followers: 4)
Heart Failure Reviews     Hybrid Journal   (Followers: 3)
Heart India     Open Access   (Followers: 2)
Heart International     Full-text available via subscription  
Heart Rhythm     Hybrid Journal   (Followers: 16)
Heart Rhythm O2     Full-text available via subscription   (Followers: 3)
Heart Views     Open Access   (Followers: 2)
HeartRhythm Case Reports     Open Access   (Followers: 1)
Hearts     Open Access   (Followers: 3)
Hellenic Journal of Cardiology     Open Access   (Followers: 2)
Herz     Hybrid Journal   (Followers: 2)
High Blood Pressure & Cardiovascular Prevention     Full-text available via subscription   (Followers: 3)
Hypertension     Full-text available via subscription   (Followers: 26)
Hypertension     Open Access   (Followers: 2)
Hypertension in Pregnancy     Hybrid Journal   (Followers: 10)
Hypertension Research     Hybrid Journal   (Followers: 4)
Ibrahim Cardiac Medical Journal     Open Access   (Followers: 1)
IJC Heart & Vessels     Open Access   (Followers: 2)
IJC Heart & Vasculature     Open Access   (Followers: 1)
IJC Metabolic & Endocrine     Open Access   (Followers: 1)
Indian Heart Journal     Open Access   (Followers: 5)
Indian Journal of Cardiovascular Disease in Women WINCARS     Open Access   (Followers: 1)
Indian Journal of Clinical Cardiology     Open Access   (Followers: 1)
Indian Journal of Thoracic and Cardiovascular Surgery     Hybrid Journal  
Indian Pacing and Electrophysiology Journal     Open Access   (Followers: 1)
Innovations : Technology and Techniques in Cardiothoracic and Vascular Surgery     Hybrid Journal   (Followers: 2)
Insuficiencia Cardíaca     Open Access  
Interactive CardioVascular and Thoracic Surgery     Hybrid Journal   (Followers: 7)
International Cardiovascular Forum Journal     Open Access  
International Journal of Angiology     Hybrid Journal  
International Journal of Cardiology     Hybrid Journal   (Followers: 18)
International Journal of Cardiology Hypertension     Open Access   (Followers: 1)
International Journal of Cardiovascular and Cerebrovascular Disease     Open Access   (Followers: 3)
International Journal of Cardiovascular Imaging     Hybrid Journal   (Followers: 2)
International Journal of Cardiovascular Research     Hybrid Journal   (Followers: 6)
International Journal of Heart Rhythm     Open Access  
International Journal of Hypertension     Open Access   (Followers: 8)
International Journal of Hyperthermia     Open Access  
International Journal of Stroke     Hybrid Journal   (Followers: 36)
International Journal of the Cardiovascular Academy     Open Access  

        1 2 | Last

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ASAIO Journal
Journal Prestige (SJR): 0.771
Citation Impact (citeScore): 2
Number of Followers: 3  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1058-2916 - ISSN (Online) 1538-943X
Published by LWW Wolters Kluwer Homepage  [301 journals]
  • Extracorporeal Oxygenation and Coronavirus Disease 2019 Epidemic: Is the
           Membrane Fail-Safe to Cross Contamination'

    • Free pre-print version: Loading...

      Authors: Squiccimarro; Enrico; Rociola, Ruggiero; Haumann, Renard Gerhardus; Grasso, Salvatore; Lorusso, Roberto; Paparella, Domenico
      Abstract: imageNo abstract available
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • Thrombosis and Coagulopathy in COVID-19 Patients Requiring Extracorporeal
           Membrane Oxygenation

    • Free pre-print version: Loading...

      Authors: Yusuff; Hakeem; Zochios, Vasileios; Brodie, Daniel
      Abstract: imageNo abstract available
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • Toward a Long-Term Artificial Lung

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      Authors: Arens; Jutta; Grottke, Oliver; Haverich, Axel; Maier, Lars S.; Schmitz-Rode, Thomas; Steinseifer, Ulrich; Wendel, H.P.; Rossaint, Rolf
      Abstract: imageOnly a very small portion of end-stage organ failures can be treated by transplantation because of the shortage of donor organs. Although artificial long-term organ support such as ventricular assist devices provide therapeutic options serving as a bridge-to-transplantation or destination therapy for end-stage heart failure, suitable long-term artificial lung systems are still at an early stage of development. Although a short-term use of an extracorporeal lung support is feasible today, the currently available technical solutions do not permit the long-term use of lung replacement systems in terms of an implantable artificial lung. This is currently limited by a variety of factors: biocompatibility problems lead to clot formation within the system, especially in areas with unphysiological flow conditions. In addition, proteins, cells, and fibrin are deposited on the membranes, decreasing gas exchange performance and thus, limiting long-term use. Coordinated basic and translational scientific research to solve these problems is therefore necessary to enable the long-term use and implantation of an artificial lung. Strategies for improving the biocompatibility of foreign surfaces, for new anticoagulation regimes, for optimization of gas and blood flow, and for miniaturization of these systems must be found. These strategies must be validated by in vitro and in vivo tests, which remain to be developed. In addition, the influence of long-term support on the pathophysiology must be considered. These challenges require well-connected interdisciplinary teams from the natural and material sciences, engineering, and medicine, which take the necessary steps toward the development of an artificial implantable lung.
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • Cost-Effectiveness of Thoracotomy Approach for the Implantation of a
           Centrifugal Left Ventricular Assist Device

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      Authors: Mahr; Claudius; McGee, Edwin Jr; Cheung, Anson; Mokadam, Nahush A.; Strueber, Martin; Slaughter, Mark S.; Danter, Matthew R.; Levy, Wayne C.; Cheng, Richard K.; Beckman, Jennifer A.; May, Damian M.; Ismyrloglou, Eleni; Tsintzos, Stelios I.; Silvestry, Scott C.
      Abstract: imageThis study reports the first analysis regarding cost-effectiveness of left ventricular assist device (LVAD) implantation via thoracotomy. Cost-effectiveness of LVADs implanted via the traditional surgical approach of sternotomy has been improved through the years because of technological advances, along with understanding the importance of patient selection and postimplant management have on positively affecting outcomes. Given the positive clinical outcomes of the thoracotomy approach, we seek to study the cost-effectiveness of a centrifugal LVAD via this less invasive approach. We developed a Markov model. Survival and quality of life inputs (QALY) for the LVAD arm were based on data from the LATERAL clinical trial. For the Medical Management arm, survival was derived from the Seattle Heart Failure Model. The heart transplant probability was derived from INTERMACS. Survival after heart transplantation used International Society for Heart and Lung Transplantation data. Cost inputs were calculated based on Medicare data and past literature. The incremental cost-effectiveness ratio was found to be $64,632 per quality adjusted life year and $57,891 per life year in the bridge to transplant indication. These results demonstrate further improvement in the overall cost-effectiveness of LVAD therapy and confirm implantation of LVADs via a less invasive approach as being cost-effective.
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • Cost-Effectiveness of a Small Intrapericardial Centrifugal Left
           Ventricular Assist Device

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      Authors: Silvestry; Scott C.; Mahr, Claudius; Slaughter, Mark S.; Levy, Wayne C.; Cheng, Richard K.; May, Damian M.; Ismyrloglou, Eleni; Tsintzos, Stelios I.; Tuttle, Edward; Cook, Keziah; Birk, Erica; Gomes, Aparna; Graham, Sophia; Cotts, William G.
      Abstract: imageThere is limited data on the cost-effectiveness of continuous-flow left ventricular assist devices (LVAD) in the United States particularly for the bridge-to-transplant indication. Our objective is to study the cost-effectiveness of a small intrapericardial centrifugal LVAD compared with medical management (MM) and subsequent heart transplantation using the respective clinical trial data. We developed a Markov economic framework. Clinical inputs for the LVAD arm were based on prospective trials employing the HeartWare centrifugal-flow ventricular assist device system. To better assess survival in the MM arm, and in the absence of contemporary trials randomizing patients to LVAD and MM, estimates from the Seattle Heart Failure Model were used. Costs inputs were calculated based on Medicare claim analyses and when appropriate prior published literature. Time horizon was lifetime. Costs and benefits were appropriately discounted at 3% per year. The deterministic cost-effectiveness analyses resulted in $69,768 per Quality Adjusted Life Year and $56,538 per Life Year for the bridge-to-transplant indication and $102,587 per Quality Adjusted Life Year and $87,327 per Life Year for destination therapy. These outcomes signify a substantial improvement compared with prior studies and re-open the discussion around the cost-effectiveness of LVADs.
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • Cost-Effectiveness of Long-Term Left Ventricular Assist Device Support: Is
           the Extra-Welfarist Model Suitable for Advanced Heart Failure'

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      Authors: Rajapreyar; Indranee; Rame, J. Eduardo
      Abstract: imageNo abstract available
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • Association Between Neurohormone Levels and Exercise Testing Measures in
           Patients with Mechanical Circulatory Supports

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      Authors: Grosman-Rimon; Liza; Kachel, Erez; McDonald, Michael A.; Lalonde, Spencer D.; Yip, Paul; Ribeiro, Roberto V.P.; Adamson, Mitchell B.; Cherney, David Z.; Rao, Vivek
      Abstract: imageContinuous-flow left ventricular assist device (CF-LVAD) recipients exhibit impaired exercise capacity. Long-term continuous blood flow also elevates norepinephrine (NE) and aldosterone (Aldo) levels. However, the relationship between exercise capacity and neurohormonal activation has not been elucidated. Our study objective was to assess the association between cardiopulmonary exercise testing (CPT) measures and neurohormonal levels in CF-LVAD recipients. Symptom-limited CPT on a treadmill, using the modified Bruce protocol was performed in 15 CF-LVAD recipients. Norepinephrine and Aldo levels were measured, and the association between their levels and CPT measures were assessed. Peak VO2 (13.6 ml/kg/min) and percent age, sex predicted VO2 max (49.4%), and oxygen pulse (O2 pulse) (9.0 ± 4.0 ml/beat) were low, whereas minute ventilation/carbon dioxide output (VE/VCO2) slope (35) was elevated. In addition, VO2 at anaerobic threshold (VO2 AT), and O2 pulse values negatively correlated with NE levels. Norepinephrine levels positively correlated with chronotropic responses and heart rate (HR) recovery. Aldo levels in CF-LVAD recipients were not related to any CPT measures. Continuous-flow left ventricular assist device recipients exhibited impaired exercise capacity and chronotropic incompetence (CI). Despite the association of NE levels with chronotropic responses at peak exercise, neither NE levels nor chronotropic responses predicted peak VO2. This suggests that CI may not be the primary factor responsible for the low peak VO2. O2 pulse, which is a combined measure for stroke volume and peripheral oxygen extraction during exercise, was an independent predictor of peak VO2. Future studies should examine the contribution of peripheral factors to exercise capacity limitations.
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • Meet the Authors

    • Free pre-print version: Loading...

      Abstract: imageNo abstract available
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • Neurohormonal Blockade During Left Ventricular Assist Device Support

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      Authors: Imamura; Teruhiko; Mehta, Priya; Nguyen, Ann; Chung, Ben; Narang, Nikhil; Rodgers, Daniel; Raikhelkar, Jayant; Smith, Bryan; Song, Tae; Ota, Takeyoshi; Jeevanandam, Valluvan; Kim, Gene; Sayer, Gabriel; Uriel, Nir
      Abstract: imageNeurohormonal blockade (NHB) is the mainstay of therapy for patients with systolic heart failure (HF). However, the efficacy in patients with left ventricular assist devices (LVADs) remains unknown. Of all, 114 LVAD patients (57 [48, 65] years old and 78% male) were enrolled and followed during the early period (6 months after index discharge), and 98 were followed during the late period (6–12 months following index discharge). Of them, 46% were on beta-blocker (BB), 49% on angiotensin-converting enzyme inhibitor (ACEi) and/or angiotensin II receptor blocker (ARB), and 51% on aldosterone antagonist at baseline. Prevalence of BB and ACEi/ARB use increased during the study period. During the early period, similar event rates were found irrespective of the NHB uses. During the late period, BB was associated with reduced HF readmission, and ACEi/ARB was associated with reduced HF readmission and gastrointestinal bleeding (p < 0.05 for all). In conclusion, BB and ACEi/ARB use during the late period was associated with a reduction in HF recurrence in LVAD patients. Further prospective randomized control trials are warranted to clarify the utility of NHB therapy in LVAD patients.
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • Tirofiban in Suspected Left Ventricular Assist Device Pump Thrombosis

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      Authors: Nei; Scott D.; Wieruszewski, Patrick M.; Orzel, Libby A.; Ritchie, Brianne M.; Stulak, John M.
      Abstract: imageAntithrombotic optimization with a glycoprotein IIb/IIIa inhibitor has been used for the treatment of suspected pump thrombosis, but available literature with tirofiban is lacking. This study aims to describe the use of tirofiban for suspected pump thrombosis. This was a single-center cohort study of left ventricular assist device patients who received tirofiban for the treatment of suspected pump thrombosis from January 1, 2016 to July 31, 2017. Tirofiban was initiated at 0.1 μg/kg/min in patients with normal renal function and subsequent dose adjustments for altered renal function or history of bleeding were employed. Success was defined as resolution of lactate dehydrogenase back to patients’ known baseline. Fourteen patients were included for 16 total instances of tirofiban use during the time period. Tirofiban was continued for a median of 5 days (range: 0.3–35 days). Successful treatment was achieved in 12 of the 16 tirofiban uses (75%). Seven bleeding events occurred while on therapy, two major and five minor. This study showed a majority of patients achieved success with tirofiban for suspected pump thrombosis. For patients who are not current candidates for pump exchange or transplant, tirofiban may be considered a therapeutic medical management option.
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • Abdominal Surgery in Patients with Ventricular Assist Devices: a
           Single-Center Report

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      Authors: Beetz; Oliver; Bajunaid, Anwar; Meißler, Luise; Vondran, Florian W. R.; Kleine, Moritz; Cammann, Sebastian; Hanke, Jasmin S.; Schmitto, Jan D.; Haverich, Axel; Klempnauer, Jürgen; Ringe, Kristina I.; Oldhafer, Felix; Timrott, Kai
      Abstract: imageThis study was performed to evaluate the incidence and outcome of patients with ventricular assist devices (VADs) undergoing abdominal surgery at our institution. A total of 604 adult patients who underwent VAD implantation between February 2004 and February 2018 were analyzed retrospectively with a median follow-up time of 66 (6–174) months. Thirty-nine patients (6.5%) underwent abdominal surgery. Elective surgical procedures were performed in 22 patients (56.4%), mainly for abdominal wall hernia repairs, partial colectomies, and cholecystectomies. Early after elective abdominal surgery no patient died, resulting in a median survival of 23 (1–78) months. Emergency surgery was performed in 17 patients (43.6%). The most common emergency indications were intestinal ischemia and/or perforation. Eight patients undergoing emergent surgery (44.4%) died within the first 30 days after primary abdominal operation, mainly due to sepsis and consecutive multiple organ failure, resulting in a dismal median survival of one month (0–52). Patients undergoing abdominal surgery had significantly lower rates of realized heart-transplantation (p = 0.031) and a significantly higher rate of VAD exchange, before or after abdominal surgery, due to thromboses or infections (p = 0.037). Nonetheless, overall survival after primary VAD implantation in these patients (median 38 months; 0–107) was not significantly impaired when compared to all other patients undergoing VAD implantation (median 30 months; 0–171). In summary, elective abdominal surgery can be performed safely when well planned by an experienced multidisciplinary team. Abdominal complications in VAD patients requiring emergent surgery, however, lead to a significant increase in short-term morbidity and a high 30-day mortality rate.
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • Biologically Inspired, Open, Helicoid Impeller Design for Mechanical
           Circulatory Assist

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      Authors: Park; Jiheum; Oki, Kristi; Hesselmann, Felix; Geirsson, Arnar; Kaufmann, Tim; Bonde, Pramod
      Abstract: imageRotating impeller actuated by electromagnet has been a key technological innovation which surpassed earlier limitations of pulsatile pumps. Current impeller design, however, is alien to the functional unit of the human circulatory system and remains a potential cause of adverse prothrombotic events such as hemolysis or pump thrombosis by forcing blood cells to pass over a narrow space available within the rapidly alternating blades attached along its central hub, creating fundamentally a nonphysiologic flow, especially for miniaturized percutaneous blood pumps. Here, we present a biologically inspired, open, helicoid (BiO-H) impeller design for a circulatory assist device that has a fundamentally different footprint from the conventional Archimedean screw-based impeller designs by implementing new design features inspired by an avian right atrioventricular valve. Design parameters including an inner diameter, helix height, overall height, helix revolutions/pitch, blade length, blade thickness, introductory blade angle, number of blades, and blade shape were optimized for maximum output volumetric flow rate through the parametric analysis in computational fluid dynamics simulation. BiO-H shows an improved flow path with 2.25-fold less cross-sectional area loss than the conventional impeller designs. BiO-H with a diameter of 15 mm resulted in a maximum flow rate of 25 L/min at 15,000 revolutions per minute in simulation and showed further improved pressure–flow relationship in benchtop experiments. The design shows promise in increasing flow and could serve as a new impeller design for future blood pumps.
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • Long-Term Survival, Posttraumatic Stress, and Quality of Life post
           Extracorporeal Membrane Oxygenation

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      Authors: Harley; Olivia; Reynolds, Claire; Nair, Priya; Buscher, Hergen
      Abstract: imageThe past years has seen a surge in usage of extracorporeal membrane oxygenation (ECMO). Little is known about long-term survival, posttraumatic stress, and quality of life (QoL). A single-centre retrospective cohort study on consecutive patients supported with ECMO between 2012 and 2016. Survivors completed a QoL questionnaire (Short-Form 36 [SF-36]) and the posttraumatic stress disorder (PTSD) Civilian Version (PCL-C). Two-hundred forty-one patients (age 52 years, 158 males) received ECMO. One hundred fifty-one patients (62.7%) survived to discharge, of these 129 (85%) were alive at a median follow-up of 31.8 months. Median survival was 56.6 months. Seventy-six (58.9%) returned a completed survey. The ECMO cohort experienced a decrease in QoL in all domains which was significantly associated with a high risk for PTSD with 30.8% in the highest PTSD risk bracket. Renal replacement therapy and duration of ECMO were significantly associated with increased mortality but not with QoL. The diagnoses of primary graft dysfunction or respiratory failure were independently associated with better long-term survival, but there was no difference in QoL between different underlying conditions. Despite good long-term survival rates, reduced QoL and PTSD were frequently observed. These findings reaffirm the need for long-term follow-up and rehabilitation in this population.
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • A Dual-Lumen Percutaneous Cannula for Managing Refractory Right
           Ventricular Failure

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      Authors: Badu; Bernice; Cain, Michael T.; Durham, Lucian A. III; Joyce, Lyle D.; Sundararajan, Sakthi; Gaglianello, Nunzio; Ishizawar, David; Saltzberg, Mitchell; Mohammed, Asim; Joyce, David L.
      Abstract: imageA right ventricular assist device (RVAD) using a dual-lumen percutaneous cannula inserted through the right internal jugular vein (IJV) might improve weaning in patients with refractory right ventricular (RV) failure. However, the reported experience with this cannula is limited. We reviewed the records of all patients receiving RVAD support with this new dual-lumen cannula at our institution between April 2017 and February 2019. We recorded data on weaning, mortality, and device-specific complications. We compared outcomes among three subgroups based on the indications for RVAD support (postcardiotomy, cardiogenic shock, and primary respiratory failure) and against similar results in the literature. Mean (standard deviation [SD]) age of the 40 patients (29 men) was 53 (15.5) years. Indications for implantation were postcardiotomy support in 18 patients, cardiogenic shock in 12, and respiratory failure in 10. In all, 17 (94%) patients in the postcardiotomy group were weaned from RVAD support, five (42%) in the cardiogenic shock group, and seven (70%) in the respiratory failure group, overall higher than those reported in the literature (49% to 59%) for surgically placed RVADs. Whereas published in-hospital mortality rates range from 42% to 50% for surgically placed RVADs and from 41% to 50% for RVADs with percutaneous cannulas implanted through the right IJV, mortality was 11%, 58%, and 40% in our subgroups, respectively. There were no major device-related complications. This percutaneous dual-lumen cannula appears to be safe and effective for managing refractory RV failure, with improved weaning and mortality profile, and with limited device-specific adverse events.
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • Analysis of Thrombotic Deposits in Extracorporeal Membrane Oxygenators by
           High-resolution Microcomputed Tomography: A Feasibility Study

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      Authors: Birkenmaier; Clemens; Dornia, Christian; Lehle, Karla; Müller, Thomas; Gruber, Michael; Philipp, Alois; Krenkel, Lars
      Abstract: imageCoagulative disorders, especially clotting during extracorporeal membrane oxygenation, are frequent complications. Direct visualization and analysis of deposits in membrane oxygenators using computed tomography (CT) may provide an insight into the underlying mechanisms causing thrombotic events. However, the already established multidetector CT1 (MDCT) method shows major limitations. Here, we demonstrate the feasibility of applying industrial micro-CT (µCT) to circumvent these restrictions. Three clinically used membrane oxygenators were investigated applying both MDCT and µCT. The scans were analyzed in terms of clot volume and local clot distribution. As validation, the clot volume was also determined from the fluid volume, which could be filled into the respective used oxygenator compared to a new device. In addition, cross-sectional CT images were compared with crosscut oxygenators. Based on the µCT findings, a morphological measure (sphericity) for assessing clot structures in membrane oxygenators is introduced. Furthermore, by comparing MDCT and µCT results, an augmentation of the MDCT method is proposed, which allows for improved clot volume determination in a clinical setting.
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • Palliative Care Engagement for Pediatric Ventricular Assist Device
           Patients: A Single-Center Experience

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      Authors: Knoll; Christopher; Kaufman, Beth; Chen, Sharon; Murray, Jenna; Cohen, Harvey; Sourkes, Barbara M.; Rosenthal, David N.; Hollander, Seth A.
      Abstract: imageOutcomes in pediatric patients with ventricular assist devices (VADs) for advanced heart failure (HF) are improving, but the risk of associated morbidity and mortality remains substantial. Few data exist on the involvement of pediatric palliative care (PPC) in this high-risk patient population. We aimed to characterize the extent of palliative care involvement in the care of patients requiring VAD placement at our institution. Single-center retrospective chart review analyzing all VAD patients at a large pediatric center over a 4 year period. Timing and extent of palliative care subspecialty involvement were analyzed. Between January 2014 and December 2017, 55 HF patients underwent VAD implantation at our institution. Pediatric palliative care utilization steadily increased over consecutive years (2014:
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • End-Stage Liver Disease Models and Outcomes in Pediatric Patients
           Supported With Short-Term Continuous-Flow Ventricular Assist Devices

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      Authors: Malik; Getanshu; Pidborochynski, Tara; Buchholz, Holger; Freed, Darren H.; Al-Aklabi, Mohammed; Bozso, Sabin J.; Choudhry, Swati; Anand, Vijay; Holinski, Paula; Conway, Jennifer
      Abstract: imageShort-term continuous-flow ventricular assist devices (STCF-VADs) are increasingly being utilized in pediatrics. End-stage liver disease (ELD) models have been associated with outcomes in adult patients on mechanical circulatory support. We sought to determine the relationship between outcomes in children on STCF-VADs and three ELD models: model for end-stage liver disease-excluding international normalized ratio (MELD-XI; all) and MELD-XI (> 1 year), PELD, and a novel score, PedMELD-XI. All patients (< 19 years) supported with STCF-VADs, between June 2009 and December 2016 were included. The MELD-XI, PELD, and PedMELD-XI scores were calculated and their association with adverse events and a composite measure of death, major bleeding, and neurologic dysfunction was analyzed. Of 32 patients, median age was 0.57 years (interquartile range [IQR], 0.10–4.43), median weight was 7.15 kg (IQR, 3.68–16.53), 53.1% had congenital heart disease, and 53.1% were male. In total, 78.1% patients experienced an adverse event (78.1% a major bleed, 25.0% neurologic dysfunction, and 15.6% death). The median MELD-XI score was 11.17 (IQR, 9.44–30.01), MELD-XI (>1 year) 9.44 (IQR, 9.44–24.33), PELD 6.00 (IQR, 4.00–13.75), and PedMELD-XI −14.91 (IQR, −18.85 to −12.25). A higher MELD-XI for all ages (13.80 vs. 9.44, p = 0.037) and less negative PedMELD-XI (−14.16 vs. −19.34, p = 0.028) scores were significantly associated with bleeding and the composite outcome. PedMELD-XI was significantly associated with death (−12.87 vs. −16.84, p = 0.041) while a trend was seen for increased MELD-XI in all ages being associated with death (31.52 vs. 10.11, p = 0.051). Last, there was no association with the models and neurologic events. MELD-XI and PedMELD-XI were significantly associated with major bleeding and the composite endpoints with PedMELD-XI also being associated with death. These results suggest that ELD models can be used to predict outcomes in this specific patient population, however, further analysis in a larger population is required.
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • Utilization and Outcomes of Children Treated with Direct Thrombin
           Inhibitors on Paracorporeal Ventricular Assist Device Support

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      Authors: VanderPluym; Christina J.; Cantor, Ryan S.; Machado, Desiree; Boyle, Gerald; May, Lindsay; Griffiths, Eric; Niebler, Robert A.; Lorts, Angela; Rossano, Joseph; Sutcliffe, David L.; Lytrivi, Irene D.; Buchholz, Holger; Fynn-Thompson, Francis; Hawkins, Beth; Conway, Jennifer
      Abstract: imageThrombotic and bleeding complications have historically been major causes of morbidity and mortality in pediatric ventricular assist device (VAD) support. Standard anticoagulation with unfractionated heparin is fraught with problems related to its heterogeneous biochemical composition and unpredictable pharmacokinetics. We sought to describe the utilization and outcomes in children with paracorporeal VAD support who are treated with direct thrombin inhibitors (DTIs) antithrombosis therapy. Retrospective multicenter review of all pediatric patients (aged
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • Outcomes of Venovenous Extracorporeal Membrane Oxygenation When Stratified
           by Age: How Old Is Too Old'

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      Authors: Deatrick; Kristopher B.; Mazzeffi, Michael A.; Galvagno, Samuel M. Jr; Tesoriero, Ronald B.; Kaczoroswki, David J.; Herr, Daniel L.; Dolly, Katelyn; Rabinowitz, Ronald P.; Scalea, Thomas M.; Menaker, Jay
      Abstract: imageThe purpose of this study was to evaluate survival to hospital discharge for patients on venovenous extracorporeal membrane oxygenation (VV ECMO) when stratified by age. We performed a retrospective study at single, academic, tertiary care center intensive care unit for VV ECMO. All patients, older than 17 years of age, on VV ECMO admitted to a specialized intensive care unit for the management of VV ECMO between August 2014 and May 2018 were included in the study. Trauma and bridge-to-lung transplant patients were excluded for this analysis. Demographics, pre-ECMO and ECMO data were collected. Primary outcome was survival to hospital discharge when stratified by age. Secondary outcomes included time on VV ECMO and hospital length of stay (HLOS). One hundred eighty-two patients were included. Median P/F ratio at time of cannulation was 69 [56–85], and respiratory ECMO survival prediction (RESP) score was 3 [1–5]. Median time on ECMO was 319 [180–567] hours. Overall survival to hospital discharge was 75.8%. Lowess and cubic spline curves demonstrated an inflection point associated with increased mortality at age>45 years. Kaplan-Meier analysis demonstrated significantly greater survival in patients
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • Veno-Venous Extracorporeal Lung Support as a Bridge to or Through Lung
           Volume Reduction Surgery in Patients with Severe Hypercapnia

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      Authors: Akil; Ali; Ziegeler, Stephan; Reichelt, Jan; Lavae-Mokhtari, Mahyar; Freermann, Stefan; Semik, Michael; Fichter, Joachim; Rehers, Stephanie; Dickgreber, Nicolas Johannes; Richter, Lars; Ernst, Erik Christian; Fischer, Stefan
      Abstract: imageExtracorporeal lung support (ECLS) represents an essential support tool especially for critically ill patients undergoing thoracic surgical procedures. Lung volume reduction surgery (LVRS) is an important treatment option for end-stage lung emphysema in carefully selected patients. Here, we report the efficacy of veno-venous ECLS (VV ECLS) as a bridge to or through LVRS in patients with end-stage lung emphysema and severe hypercapnia. Between January 2016 and May 2017, 125 patients with end-stage lung emphysema undergoing LVRS were prospectively enrolled into this study. Patients with severe hypercapnia caused by chronic respiratory failure were bridged to or through LVRS with low-flow VV ECLS (65 patients, group 1). Patients with preoperative normocapnia served as a control group (60 patients, group 2). In group 1, VV ECLS was implemented preoperatively in five patients and in 60 patients intraoperatively. Extracorporeal lung support was continued postoperatively in all 65 patients. Mean length of postoperative VV ECLS support was 3 ± 1 day. The 90 day mortality rate was 7.8% in group 1 compared with 5% in group 2 (p = 0.5). Postoperatively, a significant improvement was observed in quality of life, exercise capacity, and dyspnea symptoms in both groups. VV ECLS in patients with severe hypercapnia undergoing LVRS is an effective and well-tolerated treatment option. In particular, it increases the intraoperative safety, supports de-escalation of ventilatory strategies, and reduces the rate of postoperative complications in a cohort of patients considered “high risk” for LVRS in the current literature.
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • Lipoteichoic Acid as a Potential Noninvasive Biomarker of Biofilm in
           Dialysis Access

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      Authors: Pai; Amy Barton; McGuire, Matthew D.; Davidge, Karen N.; Dean, Michael C.; Costello, Gabrielle M.; Souza, Ernane; Mukherjee, Sushovita; Heung, Michael; Yevzlin, Alexander S.; Yessayan, Lenar T.
      Abstract: imageTunneled central venous catheters (TCVCs) are colonized by Gram-positive organisms and form biofilm. Lipoteichoic acid (LTA) is a Gram-positive cell wall component that can be measured in serum. The purpose of this pilot study was to characterize LTA concentrations in hemodialysis (HD) patients with TCVCs compared to other access types and to evaluate biofilm morphology and microbiology in TCVCs removed by clinical decision. The study enrolled patients with TCVCs (18), grafts (19), and fistulas (18). Blood samples were collected before HD, at 30 minutes, 2 hours, and end of HD. Catheters removed by clinical decision were evaluated by scanning electron microscopy (SEM) for biofilm morphology, and portions of the catheter were cultured. LTA was detectable in all samples and concentrations increased significantly in all access types during HD (p < 0.05 for all comparisons). Patients with TCVCs that had a>30% increase in LTA concentration from baseline also had the greatest rate of increase (slope) compared to grafts and fistulas (p = 0.03 and p = 0.04, respectively). Catheters removed by clinical decision (n = 7) and examined by SEM had deposition of fibrin. Cultures revealed polymicrobial colonization. TCVCs had the highest rate of increase of LTA during HD. Further studies to determine the source of LTA in patients with AVG and AVF are warranted.
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • Aloe Vera–Derived Gel-Blended PHBV Nanofibrous Scaffold for Bone
           Tissue Engineering

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      Authors: Tahmasebi; Aylin; Shapouri Moghadam, Abbas; Enderami, Seyed Ehsan; Islami, Maryam; Kaabi, Mohamad; Saburi, Ehsan; Daei Farshchi, Amir; Soleimanifar, Fatemeh; Mansouri, Vahid
      Abstract: imageToday, composite scaffolds fabricated by natural and synthetic polymers have attracted a lot of attention among researchers in the field of tissue engineering, and given their combined properties that can play a very useful role in repairing damaged tissues. In the current study, aloe vera–derived gel-blended poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) nanofibrous scaffold was fabricated by electrospinning, and then, PHBV and PHBV gel fabricated scaffolds characterized by scanning electron microscope, protein adsorption, cell attachment, tensile and cell’s viability tests. After that, osteogenic supportive property of the scaffolds was studied by culturing of human-induced pluripotent stem cells on the scaffolds under osteogenic medium and evaluating of the common bone-related markers. The results showed that biocompatibility of the PHBV nanofibrous scaffold significantly improved when combined with the aloe vera gel. In addition, higher amounts of alkaline phosphatase activity, mineralization, and bone-related gene and protein expression were detected in stem cells when grown on PHBV-gel scaffold in comparison with those stem cells grown on the PHBV and culture plate. Taken together, it can be concluded that aloe vera gel–blended PHBV scaffold has a great promising osteoinductive potential that can be used as a suitable bioimplant for bone tissue engineering applications to accelerate bone regeneration and also degraded completely along with tissue regeneration.
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • Right Ventricular Device HeartWare Implant to the Right Atrium with
           Fixation to the Chest Wall in Patient with Biventricular Support

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      Authors: Chamogeorgakis; Themistokles; Cowger, Jennifer; Apostolou, Dimitrios; Tanaka, Daizo; Nemeh, Hassan
      Abstract: imageNo abstract available
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • Ischemic Stroke and Intracranial Hemorrhages During Impella Cardiac
           Support

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      Authors: Hassett; Catherine E.; Cho, Sung-Min; Hasan, Saad; Rice, Cory J.; Migdady, Ibrahim; Starling, Randall C.; Soltesz, Edward; Uchino, Ken
      Abstract: imageImpella is a percutaneously placed, ventricular assist device for short-term cardiac support. We aimed to study acute neurologic complications during short-term cardiac support with Impella. We reviewed prospectively collected data of 79 consecutive persons implanted with Impella at a single tertiary center. Acute neurologic events (ANE) were defined as ischemic strokes or intracranial hemorrhages. Among those with ANE, specific causes of ischemic and hemorrhagic events were collected and discussed. Of 79 persons with Impella with median 8 days of support (range 1–33 days), six (7.5%) developed ANE at a median of 5 days from implant (range 1–8 days). There were three ischemic strokes, two intracerebral hemorrhages, and one subdural hematoma. Hemorrhagic events were attributed to anticoagulant use and thrombocytopenia at the time of the events. Two ischemic strokes were attributed to inadequate anticoagulation with one case of pump thrombosis diagnosed at the time of ischemic stroke. Only two of the six patients survived the acute cardiogenic shock period to achieve heart transplantation. In-hospital ischemic strokes and intracranial hemorrhages are not uncommon during short-term cardiac support period with Impella. Antithrombotic intensity, duration of device support time, and thrombocytopenia might contribute to the incidence of these events.
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • Adding Inflammation to the Perfect Cytokine Storm: Concerns Related to
           Extracorporeal Membrane Oxygenation for COVID-19 Patients

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      Authors: Angouras; Dimitrios C.; Kollias, Vasilios D.; Dougenis, Dimitrios
      Abstract: No abstract available
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • One Disaster After Another or a Timely Help' The Role of ECMO for
           COVID-19 Patients

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      Authors: Li; Xin; Guo, Zhen; Huang, Jiapeng
      Abstract: No abstract available
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • Choice of ECMO as a Therapy in COVID-19'

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      Authors: Raman; Lakshmi; Bartlett, Robert h.; Paden, Matthew L.
      Abstract: No abstract available
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
  • Erratum: Initial ELSO Guidance Document: ECMO for COVID-19 Patients with
           Severe Cardiopulmonary Failure

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      Abstract: imageNo abstract available
      PubDate: Sat, 01 Aug 2020 00:00:00 GMT-
       
 
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