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Thorsten Drews

Publications and source records attributed to Thorsten Drews.

11 recordsLinked to original sources
PubMed2007

Impact of heparin-induced thrombocytopenia on outcome in patients with ventricular assist device support: single-institution experience in 358 consecutive patients.

BACKGROUND: Cardiac surgical patients are at an approximate 1% to 2% risk of experiencing heparin-induced thrombocytopenia (HIT), a severe immune-mediated disease that is associated with thromboembolic events. We assessed the occurrence of this disease and its influence on clinical outcome in patients after implantation of a ventricular assist device (VAD). METHODS: This retrospective analysis assessed data from our adult patient VAD program between the years 2000 and 2005. Patients were divided into three groups: those without confirmed HIT ((non)HIT), those in whom the diagnosis of HIT was made before VAD implantation (HIT(pre)), and those who experienced HIT after VAD implantation (HIT(post)). End points assessed were procedural success, as defined by discharge from hospital or transplantation or recovery of the failing heart, as opposed to death before procedural success was achieved. RESULTS: The data of 358 consecutive patients were analyzed. There were 330 (non)HIT patients (91.6%), 15 HIT(pre) patients (4.5%), and 13 HIT(post) patients (3.9%). Procedural success was observed in 50% of (non)HIT patients, 67% of HIT(pre) patients, and 31% of HIT(post) patients. CONCLUSIONS: Heparin-induced thrombocytopenia is a frequent complication in VAD patients and is associated with detrimental outcome when occurring after implantation. Preoperative diagnosis of HIT and the implementation of alternative anticoagulation procedures appears to be associated with better results. Early detection of HIT antibodies before or shortly after VAD implantation and immediate implementation of an alternative anticoagulation regimen may be a strategy to improve outcome.

Adult↗
PubMed2006

Patients supported for over 4 years with left ventricular assist devices.

Ventricular assist device implantation has become an established therapy in adults and children for bridging to heart transplantation or to aid myocardial recovery. Recently, implantation of left ventricular assist devices as definitive therapy has been recognized as a better option than pharmacological treatment in patients who are not candidates for heart transplantation. This study presents our institution's experience with five patients successfully supported by two different left ventricular assist devices for over 4 years. This unique experience shows that left ventricular assist device support can be extended beyond 4 years with good quality of life and low risk, making it a good alternative for non-transplant candidates.

Adult↗
PubMed2006

Role of ventricular assist devices in the German heart allocation system.

The Eurotransplant (ET) allocation algorithm, newly implemented in 2000, gives priority for heart transplantation (HTx) to patients with high urgency (HU) status, but now this status is rescinded upon ventricular assist device (VAD) implantation and only regained if severe complications occur during mechanical circulatory support (MCS). We studied the effects of this change on the patients in our institute who were waiting for HTx with MCS. The median duration of MCS until HTx in adult patients gradually increased from 3.1 months in 1994, reaching a peak of 16.7 months in 2000, and then gradually decreased to 6.0 months in 2003. Among the patients with VAD implantation as a bridge to HTx, two patients were on MCS for more than 1 year (the longest duration of MCS being 1.6 years) at the end of 1999, and this figure increased to nine patients and a maximum MCS duration of 3.7 years at the end of 2003. These data imply that the patients in whom a complication occurred in the early phase of MCS and who had overcome this complication underwent HTx early with HU status, and those who were stable during MCS waited a long time for HTx. Furthermore, the number of patients in the latter group is increasing. The new allocation algorithm imposes on patients with MCS waiting for HTx who are relatively young and free from complications and serious coexisting disease, very long-term MCS without an end to VAD bridging, which is almost equivalent to destination therapy.

Algorithms↗
PubMed2006

Mechanical cardiac support in the young with the Berlin Heart EXCOR pulsatile ventricular assist device: 15 years' experience.

The pediatric-size pneumatically driven pulsatile extracorporeal ventricular assist device (VAD) Berlin Heart EXCOR (Berlin Heart Mediprodukt GmbH, Berlin, Germany) was introduced into clinical practice by the German Heart Institute Berlin in 1992. Until July 1, 2005, Berlin Heart EXCOR systems have been used for circulatory support in 68 children up to 18 years of age with severe circulatory failure resistant to pharmacologic therapy. These were patients suffering from cardiomyopathy, fulminant myocarditis, end-stage congenital cardiac defects, and acute heart failure following congenital heart surgery. Mean VAD support time was 35 days (range, 0 to 420 days). Forty-two patients (62%) survived to transplantation or after weaning; 37 patients (54%), including eight infants, were discharged home. These results in patients with very advanced disease have improved significantly in recent years because of technical developments and growing experience in the treatment of patients on the device, in postoperative care and optimal timing for VAD implantation. Timely implantation of the Berlin Heart EXCOR in the course of progressive heart failure now appears to be justified because the system has undergone the necessary modifications and the accumulation of clinical knowledge has made its use highly reliable and safe.

Adolescent↗
PubMed2004

Consumption of blood products during mechanical circulatory support in children: comparison between ECMO and a pulsatile ventricular assist device.

OBJECTIVE: Different mechanical circulatory support (MCS) systems are used in children with intractable heart failure. However, the need for anticoagulation leads to hemorrhage with subsequent use of blood products. We compared the coagulation disorders and the need for blood products in children treated either with extracorporeal membrane oxygenation (ECMO) or with the Berlin Heart pulsatile pneumatic ventricular assist device. PATIENTS: We retrospectively reviewed the first 8-day course of 64 children who were on MCS for more than 2 days between 1990 and 2002. Thirty children (median age 7.4 years, weight 25.5 kg) received Berlin Heart support and 34 children (median age 1.8 years, weight 9.2 kg) ECMO. Anticoagulation was accomplished by continuous infusion of heparin. Red blood cell count, platelet count, aPTT, AT III, fibrinogen, and ACT were measured regularly. Depending on blood loss and the coagulation disorder, red blood cells, fresh frozen plasma, platelets, and AT III were substituted. RESULTS: There were no preoperative differences in hematological parameters between the two groups. In the Berlin Heart group platelet transfusion was 4.3 ml x kg x day vs 24.6 ml x kg x day in the ECMO group. Red blood cell substitution was 17.2 vs 60.3 ml.kg.day. Fresh frozen plasma substitution was 8.5 ml x kg x day vs 46.9 ml x kg x day (P<0.001). Even in the congenital heart defect subgroups, when MCS was implanted without recent cardiotomy, the differences were significant. Nevertheless, the mean daily values for hemoglobin, platelets, and fibrinogen were lower in the ECMO group. There was lower overall mortality in the Berlin Heart group. CONCLUSIONS: Compared to ECMO, use of the Berlin Heart in children results in less blood loss and lower consumption of red blood cells, platelets, and fresh frozen plasma.

Adolescent↗
PubMed2004

Initial experience with miniature axial flow ventricular assist devices for postcardiotomy heart failure.

BACKGROUND: The recently introduced Impella Recover (Impella CardioSystems AG, Aachen, Germany) microaxial flow left and right ventricular assist devices (LVAD/RVAD) were evaluated as they provide circulatory support in the setting of postcardiotomy heart failure refractory to high-dose inotropic and intra-aortic balloon pump (IABP) support. METHODS: Between May 2002 and November 2002, the Recover LVAD was implanted in six patients (64 +/- 11 years) with acute left heart failure following coronary artery bypass procedures. Preoperative left ventricular (LV) ejection fraction was compromised (28% +/- 12%, 12% to 45%). Three patients presented with unstable circulation or cardiogenic shock following acute myocardial infarction, with a predicted mortality rate of 44% +/- 11% (EuroSCORE). Intraoperatively, severe heart failure was present with a more than 70% mortality rate predicted by the IABP score. The Recover RVAD and LVAD were combined to provide biventricular assist device (BVAD) support in one case of post-transplant graft failure. RESULTS: The Recover LVAD delivered blood flows of up to 5 L/min. A moderate degree of hemolysis and a reduction in platelet count were noted. Four patients were weaned from the LVAD after 169 +/- 34 hours, two of whom remain long-term survivors. Full recovery of graft function allowed weaning of the patient from BVAD support after six days. CONCLUSIONS: The initial experience with the Impella Recover VADs proved the new systems to be advantageous regarding the ease of implantation and device removal, low anticoagulation requirements, and advanced weaning features. In cases of severe heart failure, survival was improved by using LVADs when compared to that predicted by solely continuing IABP and drug support.

Aged↗
PubMed2004

Permanent mechanical circulatory support in patients of advanced age.

OBJECTIVE: This study details our initial results of long-term left ventricular assist device (LVAD) support in patients suffering from catecholamine-dependent end-stage heart failure or cardiogenic shock with age above 65 years or age above 60 and contraindications to cardiac transplantation. METHODS: Between September 2000 and July 2002, 27 patients received implantation of left ventricular assist devices (Micromed DeBakey (n=15), Berlin Heart Excor (n=6), Arrow Lion Heart (n=4) and Novacor N100 (n=2)). The mean age of this group was 66.2+/-4.1 (60-77) years. The patients presented with the following features by the time of LVAD implantation: failure of weaning from inotropic support (78%), either profound cardiogenic shock (37%) or instable hemodynamic status (22%), high-dose inotropic (52%) or intraaortic balloon pump support (11%), dialysis (15%), artificial ventilation (15%), and at least one previous cardiac procedure (44%). RESULTS: The cumulative survival rate for the whole group was 63% at 30 days, 30% at 180 days, and 22% at 2 years. The presence of preoperative cardiogenic shock was associated with a higher perioperative mortality rate. Late complications (n=7) included replacement of two thrombosed DeBakey LVADs and five late deaths secondary to thrombembolism/intracranial hemorrhage (DeBakey LVAD, n=3) or septicemia (n=2). As of May 15, 2003, six patients remain on LVAD support for an average of 653 (339-953) days, three patients now for more than 2 years. Ten patients were discharged home to spend 73% of their life span on out-of-hospital long-term LVAD support. CONCLUSION: This study reports the first single-center experience of permanent LVAD support in patients of advanced age. For this initial experience, many patients with critical circulatory status and previous cardiac operations were included and a high postoperative mortality rate was encountered among them. Older age and associated multimorbidity are the key determinants rendering the conditions of LVAD therapy for this patient cohort to be different from the bridge-to-transplant experience. The LVADs employed in this study showed different capabilities with regard to long-term support. Our experience shows that permanent mechanical circulatory support does have the potential to evolve as a treatment option in selected elderly patients with end-stage heart failure.

Aged↗
PubMed2004

First experiences with a novel magnetically suspended axial flow left ventricular assist device.

UNLABELLED: Axial flow pumps have gained increased acceptance since their first clinical use in 1998. The present report summarizes the clinical experience with patients treated for severe cardiogenic shock for the first time with a newly developed axial flow pump with magnetically levitated bearings. MATERIAL AND METHODS: The axial flow pump Incor was implanted in 24 patients between June 2002 and June 2003. All except one patient were men. In 16 patients dilative cardiomyopathy, in seven ischemic and in one restrictive cardiomypathy had been diagnosed. All patients presented with catecholamine-dependent end-stage heart failure, seven of them were on an artificial ventilator and three were dependent on intraaortic balloon pump support. All patients suffered from organ dysfunction resulting from low cardiac output. RESULTS: There were no perioperative deaths. The 30-day mortality rate was 8% (n = 2); 79% ( n = 19) of patients reached a condition to be discharged home. The cumulative time on the device is 6.9 years; the longest individual time up to July 1, 2003 is 12.6 months. There were no structural defects or failures of the system. In one case the controller had to be exchanged because of intermittent malfunction. Cardiac output ranged between 4 and 6 l in all instances and there were no cases of infection of the drive-line or the system. Hemolysis was present initially but was not detectable in the later course. There were three instances of transient ischemic attacks. Two patients developed late cardiac tamponade with re-opening of the chest after 9 and 14 days. In one patient persistent gastrointestinal bleeding required re-hospitalization and transfusion therapy. Two patients were weaned from the device after 6 and 7 months of support, respectively. CONCLUSION: The preliminary clinical experience with Incor is promising. The flow is sufficient for recovery from multiorgan failure and the pump allows long-term hemolysis-free support. The concept of magnetically levitated bearings has proven to be durable and reliable. In the case that the heart may recover through unloading, weaning from the pump is possible.

Adult↗
PubMed2002

Implantation of a left ventricular assist device in situs inversus.

A 42-year-old man with situs inversus was referred to our institution because of end-stage ischemic cardiomyopathy. Cardiac arrest occurred after admission, and the patient underwent cardiopulmonary resuscitation. An extracorporeal left ventricular assist device (Berlin Heart) was implanted as a bridge to transplantation. This is one of the first reports of left ventricular assist device implantation in a patient with situs inversus and ischemic cardiomyopathy.

Adult↗
PubMedDate not supplied

Executive cognitive dysfunction without stroke after long-term mechanical circulatory support.

Among patients who receive heart transplantation (HTx) after long-term mechanical circulatory support (MCS), some show executive cognitive dysfunction without a history of stroke. Fifty HTx patients (19 patients on MCS for longer than 3 months before HTx and 31 patients without MCS as control group) were enrolled in the study. All subjects were men aged between 20 and 59 years without a history of stroke. Patients with MCS were divided into two groups: the AH-Thr group (n = 11), in which thrombus was detected in the left ventricular assist device (LVAD) and quickly removed (mean 3.3 times); and the AH group (n = 8), in which there was no detectable thrombus in the LVAD. The Trail Making Test (TMT) and the Wisconsin Card Sorting Test (WCST) were administered. The AH-Thr group showed poorer cognitive performance both in the TMT part B, with longer completion time (p < 0.05 versus the other two groups), and in the WCST, with more perseverative errors (p < 0.001 versus the other two groups). These data indicate that patients in the AH-Thr group showed executive cognitive dysfunction in set-shifting ability, suggesting frontal lobe damage. The conditions that facilitate thrombus formation in the LVAD may induce executive cognitive dysfunction without stroke.

Adult↗