Shehab, S, Rao, S, Macdonald, P, Newton, PJ, Spratt, P, Jansz, P & Hayward, CS 2018, 'Outcomes of venopulmonary arterial extracorporeal life support as temporary right ventricular support after left ventricular assist implantation', JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, vol. 156, no. 6, pp. 2143-2152.View/Download from: UTS OPUS or Publisher's site
Shehab, S, Allida, SM, Davidson, PM, Newton, PJ, Robson, D, Jansz, PC & Hayward, CS 2017, 'Right Ventricular Failure Post LVAD Implantation Corrected with Biventricular Support: An In Vitro Model.', ASAIO Journal, vol. 63, no. 1, pp. 41-47.View/Download from: UTS OPUS or Publisher's site
Right ventricular failure after left ventricular assist device (LVAD) implantation is associated with high mortality. Management remains limited to pharmacologic therapy and temporary mechanical support. Delayed right ventricular assist device (RVAD) support after LVAD implantation is associated with poorer outcomes. With the advent of miniaturized, durable, continuous flow ventricular assist device systems, chronic RVAD and biventricular assist device (BiVAD) support has been used with some success. The purpose of this study was to assess combined BiVAD and LVAD with delayed RVAD support within a four-elemental mock circulatory loop (MCL) simulating the human cardiovascular system. Our hypothesis was that delayed continuous flow RVAD (RVAD) would produce similar hemodynamic and flow parameters to those of initial BiVAD support. Using the MCL, baseline biventricular heart failure with elevated right and left filling pressures with low cardiac output was simulated. The addition of LVAD within a biventricular configuration improved cardiac output somewhat, but was associated with persistent right heart failure with elevated right-sided filling pressures. The addition of an RVAD significantly improved LVAD outputs and returned filling pressures to normal throughout the circulation. In conclusion, RVAD support successfully restored hemodynamics and flow parameters of biventricular failure supported with isolated LVAD with persistent elevated right atrial pressure.
Allida, SM, Inglis, SC, Davidson, PM, Hayward, CS, Shehab, S & Newton, PJ 2016, 'A survey of views and opinions of health professionals managing thirst in chronic heart failure', CONTEMPORARY NURSE, vol. 52, no. 2-3, pp. 244-252.View/Download from: UTS OPUS or Publisher's site
Shehab, S, Macdonald, PS, Keogh, AM, Kotlyar, E, Jabbour, A, Robson, D, Newton, PJ, Rao, S, Wang, L, Allida, S, Connellan, M, Granger, E, Dhital, K, Spratt, P, Jansz, PC & Hayward, CS 2016, 'Long-term biventricular HeartWare ventricular assist device support-Case series of right atrial and right ventricular implantation outcomes.', Journal of Heart and Lung Transplantation, vol. 35, no. 4, pp. 466-473.View/Download from: UTS OPUS or Publisher's site
There is limited information on outcomes using the HeartWare ventricular assist device (HVAD; HeartWare, Framington, MA) as a biventricular assist device, especially with respect to site of right ventricular assist device (RVAD) implantation.Outcomes in 13 patients with dilated cardiomyopathy and severe biventricular failure who underwent dual HVAD implantation as bridge to transplantation between August 2011 and October 2014 were reviewed.Of 13 patients, 10 were Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Level 1, and 3 were INTERMACS Level 2. Mean age was 45 ± 11 years, and mean body mass index was 26 ± 4 kg/m(2). There were 7 patients on temporary mechanical support pre-operatively (extracorporeal life support, n = 5; intra-aortic balloon pump, n = 2). The median hospital length of stay was 53 days (interquartile range [IQR] 33-70 days) with a median intensive care unit length of stay of 14 days (IQR 8-36 days). The median length of support on device was 269 days (IQR 93-426 days). The right HVAD was implanted in the right ventricular (RV) free wall in 6 patients and in the right atrial (RA) free wall in 7 patients. Transplantation was successfully performed in 5 patients, and overall survival for the entire cohort was 54%. RVAD pump thrombosis occurred in 3 of 6 RV pumps and 1 of 7 RA pumps. No left ventricular assist device pump thrombosis was observed. Bleeding tended to be higher in the RV implantation group (3 of 6 vs 0 of 7). During follow up, 6 patients died (4 of 7 in the RA group vs 2 of 6 in the RV group). Cause of death was multiple-organ failure in 3 patients, sepsis in 2 patients, and intracerebral hemorrhage in 1 patient.Critically ill patients who require biventricular support can be successfully bridged to transplant using 2 HVADs. RA implantation may allow right heart support with lower pump thrombosis and bleeding complications, although this was at the expense of a higher mortality in this cohort.
Shehab, S, Newton, PJ, Allida, S, Jansz, P & Hayward, SC 2016, 'Biventricular mechanical support devices – clinical perspectives', Expert Review of Medical Devices, vol. 13, no. 4, pp. 353-365.View/Download from: Publisher's site
Inglis, S, Hermis, A, Shehab, S, Newton, PJ, Lal, S & Davidson, PM 2013, 'Peripheral arterial disease and chronic heart failure: a dangerous mix', Heart Failure Reviews, vol. 18, no. 4, pp. 457-464.View/Download from: UTS OPUS or Publisher's site
Chronic heart failure (CHF) is associated with a high comorbidity burden, adverse impact on quality of life and high health care utilisation. Peripheral arterial disease (PAD) and CHF share many risk, pathophysiological and prognostic features, and each has been associated with increased morbidity and mortality. PAD often goes undetected, and yet in spite of the availability of screening tools, this is not commonly considered in CHF care. A review of the electronic databases Medline, CINAHL and Cochrane CENTRAL was undertaken using the MeSH terms peripheral arterial disease, peripheral vascular disease, intermittent claudication and heart failure to identify studies examining the prevalence and clinical outcomes of coexisting PAD in patients with CHF. Five studies were identified. There are limited data describing the impact of PAD on CHF outcomes. As PAD may contribute to decreased capacity to exercise and other self-care behaviours, identifying those at risk and providing appropriate therapy are important. Based on this review, patients who are smokers and those with diagnosed coronary heart disease and diabetes should be targeted for the screening of PAD.