Prichard, R., Hayward, C., Davidson, P., Newton, P., Goodall, S. & Kershaw, L. 2018, 'Left ventricular device implantation impacts on hospitalisation rates, length of stay and out of hospital time', Heart, Lung and Circulation, vol. 27, no. 6, pp. 708-715.View/Download from: Publisher's site
Jain, P., Prichard, R.A., Connellan, M.B., Dhital, K.K. & Macdonald, P. 2017, 'Long distance heart transplantation: a tale of two cities', Internal Medicine Journal, vol. 47, no. 10, pp. 1202-1205.View/Download from: UTS OPUS or Publisher's site
In this 'paired' case report, we describe two heart transplants performed 3days apart at our centre. Both cases involved very prolonged transportation time of the donor heart. In one case, the donor heart was transported in an ice chest, while in the other case the organ was transported using a normothermic ex vivo perfusion (NEVP) system. The additional retrieval costs incurred by the use NEVP were more than offset by the reduction in subsequent inpatient costs.
Abshire, M., Prichard, R., DiGiacomo, M., Cajita, M. & Dennison Himmelfarb, C. 2016, 'Adaptation and Coping in patients living with an LVAD: a metasynthesis', Heart and Lung: the journal of acute and critical care, vol. 45, no. 5, pp. 397-405.View/Download from: UTS OPUS or Publisher's site
To synthesize information supporting coping and adaptation of LVAD patients and to identify opportunities for future interventions.
Left Ventricular Assist Device (LVAD) patients demonstrate improvements in quality of life and functional status, but qualitative research has not been meaningfully integrated.
Qualitative meta-synthesis using Lazarus and Folkmans' Transactional Model of stress and coping.
Four distinct stages of adaptation were identified: Pre-LVAD, Implant Hospitalization, Early Home Adaptation and Late Home Adaptation. Each stage includes tasks in physical, psychological and social domains. Two themes emerged: 1) Primary Appraisal: Every stage is a new challenge and 2) Secondary Appraisal: Routines are achievable, emotions are more difficult.
Emotional challenges including fear and anxiety related to life-limiting illness and changed social roles need to be honestly addressed. Individuals living with LVAD achieve a sense of independence, enjoy social interactions and meaningful activities through addressing practical and emotional problems to facilitate coping.
Hayward, C.S., Salamonsen, R., Keogh, A.M., Woodard, J., Ayre, P., Prichard, R., Kotlyar, E., Macdonald, P.S., Jansz, P. & Spratt, P. 2015, 'Impact of left ventricular assist device speed adjustment on exercise tolerance and markers of wall stress', INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS, vol. 38, no. 9, pp. 501-507.View/Download from: Publisher's site
Muthiah, K., Robson, D., Prichard, R., Walker, R., Gupta, S., Keogh, A.M., Macdonald, P.S., Woodard, J., Kotlyar, E., Dhital, K., Granger, E., Jansz, P., Spratt, P. & Hayward, C.S. 2015, 'Effect of exercise and pump speed modulation on invasive hemodynamics in patients with centrifugal continuous-flow left ventricular assist devices.', The Journal of Heart and Lung Transplantation, vol. 34, no. 4, pp. 522-529.View/Download from: UTS OPUS or Publisher's site
Continuous-flow left ventricular assist devices (CF-LVADs) improve functional capacity in patients with end-stage heart failure. Pump output can be increased by increased pump speed as well as changes in loading conditions.The effect of exercise on invasive hemodynamics was studied in two study protocols. The first examined exercise at fixed pump speed (n = 8) and the second with progressive pump speed increase (n = 11). Patients underwent simultaneous right-heart catheterization, mixed venous saturation, echocardiography and mean arterial pressure monitoring. Before exercise, a ramp speed study was performed in all patients. Patients then undertook symptom-limited supine bicycle exercise.Upward titration of pump speed at rest (by 11.6 ± 8.6% from baseline) increased pump flow from 5.3 ± 1.0 to 6.3 ± 1.0 liters/min (18.9% increase, p < 0.001) and decreased pulmonary capillary wedge pressure (PCWP; 13.6 ± 5.4 to 8.9 ± 4.1 mm Hg, p < 0.001). Exercise increased pump flow to a similar extent as pump speed change alone (to 6.2 ± 1.0 liters/min, p < 0.001), but resulted in increased right- and left-heart filling pressures (right atrial pressure [RAP]: 16.6 ± 7.5 mm Hg, p < 0.001; PCWP 24.8 ± 6.7 mm Hg, p < 0.001). Concomitant pump speed increase with exercise enhanced the pump flow increase (to 7.0 ± 1.4 liters/min, p < 0.001) in Protocol 2, but did not alleviate the increase in pre-load (RAP: 20.5 ± 8.0 mm Hg, p = 0.07; PCWP: 26.8 ± 12.7 mm Hg; p = 0.47). Serum lactate and NT-proBNP levels increased significantly with exercise.Pump flow increases with up-titration of pump speed and with exercise. Although increased pump speed decreases filling pressures at rest, the benefit is not seen with exercise despite concurrent up-titration of pump speed.
Gupta, S., Woldendorp, K., Muthiah, K., Robson, D., Prichard, R., Macdonald, P.S., Keogh, A.M., Kotlyar, E., Jabbour, A., Dhital, K., Granger, E., Spratt, P., Jansz, P. & Hayward, C.S. 2014, 'Normalisation of haemodynamics in patients with end-stage heart failure with continuous-flow left ventricular assist device therapy.', Heart, Lung and Circulation, vol. 23, no. 10, pp. 963-969.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: New generation continuous-flow left ventricular assist devices (LVADs) utilise centrifugal pumps. Data concerning their effect on patient haemodynamics, ventricular function and tissue perfusion is limited. We aimed to document these parameters following HeartWare centrifugal continuous-flow LVAD (HVAD) implantation and to assess the impact of post-operative right heart failure (RHF). METHODS: We reviewed 53 consecutive patients (mean age 49.5 ± 14.1 yrs) with HVAD implanted in the left ventricle, at St. Vincent's Hospital, Sydney, between January 2007 and August 2012. Available paired right heart catheterisation (n=35) and echocardiography (n=39) data was reviewed to assess response of invasive haemodynamics and ventricular function to LVAD support. RESULTS: A total of 28 patients (53%) were implanted from interim mechanical circulatory support. Seventeen patients (32%) required short-term post-implant veno-pulmonary artery extracorporeal membrane oxygenation. At 100 ± 61 days post-implant, mean pulmonary artery pressure and mean pulmonary capillary wedge pressure decreased from 38.8 ± 7.7 to 22.9 ± 7.7 mmHg and 28.3 ± 6.4 to 13.4 ± 5.4 mmHg respectively (p<0.001). LV end diastolic diameter decreased from 71.3 ± 12.7 to 61.1 ± 13.7 mm and LV end-systolic diameter from 62.7 ± 12.3 to 53.9 ± 14.4mm (p<0.001). Aortic regurgitation remained trivial. Serum sodium increased from 133.3 ± 5.7 to 139.3 ± 2.8 mmol/L and creatinine decreased from 109.1 ± 42.5 to 74.3 ± 26.2 mol/L (p<0.001). Across the entire cohort, the six-month survival/transplant rate was significantly lower for RHF patients (72.2%, n=18) compared to those without (96.9%, n=35, p=0.01). CONCLUSIONS: HVAD support improves haemodynamics, LV dimensions and renal function. Following implantation with a centrifugal continuous-flow LVAD, RHF remains a significant risk with a tendency to worse outcomes in the short to medium term.
Prichard, R.A., Juul, M., Gazibarich, G., Davidson, P.M., Mason, C., Keogh, A.M., Macdonald, P.S. & Hayward, C.S. 2014, 'Six-minute walk distance predicts VO2 (max) in patients supported with continuous flow left ventricular assist devices', The International Journal of Artificial Organs, vol. 37, no. 7, pp. 539-545.View/Download from: Publisher's site
Hayward, C.S., Salamonsen, R., Keogh, A.M., Woodard, J., Ayre, P., Prichard, R., Walker, R., Kotlyar, E., Macdonald, P.S., Jansz, P. & Spratt, P. 2011, 'Effect of Alteration in Pump Speed on Pump Output and Left Ventricular Filling with Continuous-Flow Left Ventricular Assist Device', ASAIO JOURNAL, vol. 57, no. 6, pp. 495-500.View/Download from: UTS OPUS or Publisher's site
Prichard, R.R., Newton, P.J., Davidson, P.M., Goodall, S., Macdonald, P.S., Zhao, F.L. & Hayward, C.S. 2017, 'Quality of life in advanced heart failure-disconnect between patients' and clinicians' perceptions, independent of clinician experience.', EUROPEAN JOURNAL OF HEART FAILURE, WILEY, pp. 250-250.
Prichard, R., Hayward, C., Davidson, P., Goodall, S. & Newton, P. 2016, 'Impact of Left Ventricular Assist Device Implantation on Hospitalisation, and Readmissions Using a Linked Administrative Dataset', Heart Lung and Circulation, The Cardiac Society of Australia and New Zealand, Elsevier, Adelaide, pp. S114-S114.
Prichard, R.A., Newton, P., Goodall, S., Kershaw, L., Davidson, P.M., Homer, T., McNeil, F. & Hayward, C.S. 2016, 'Establishing Institutional Costs in the Year Before and After VAD Implant and Before Heart Transplant', JOURNAL OF HEART AND LUNG TRANSPLANTATION, pp. S272-S272.
Lai, J.V., Muthiah, K., Prichard, R., Walker, R., Robson, D., Lim, C., Wang, L.W., Macdonald, P.S., Jansz, P. & Hayward, C.S. 2014, 'Evaluation of Pump Speed Changes with Exercise in Patients with Continuous Flow Ventricular Assist Devices', JOURNAL OF HEART AND LUNG TRANSPLANTATION, pp. S155-S156.