Archive: Mar 2015

  1. Tensions and Needs of VAD Caregivers

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    Destination LVAD Devices Come With Caregivers’ Concerns and Tensions


    MedicalResearch.com Interview with:
    Colleen K. McIlvennan, DNP, ANP
    Assistant Professor of Medicine
    University of Colorado, Division of Cardiology
    Section of Advanced Heart Failure and Transplantation

    concerned wife

    Medical Research: What is the background for this study?

    Response: Destination therapy left ventricular assist device (DT LVAD) patients are often older with significant comorbidities that preclude heart transplantation. As such, the decision to get a DT LVAD is arguably more complicated than the decision to receive a temporary LVAD in anticipation of a transplant. Centers offering LVADs often require the identification of a caregiver prior to proceeding with the implant. Caregivers are commonly female spouses of DT LVAD patients, who are also older with co-morbidities. Understanding their perspective in DT LVAD decision making is extremely important as they are at particular risk for experiencing stress and caregiver burden due to the increased demands on caregiving with DT LVAD.

    Medical Research: What are the main findings?

    Response: We performed semi-structured qualitative interviews with 17 caregivers: 10 caregivers of patients living with DT LVAD, 6 caregivers of patients who had died with DT LVAD, and 1 caregiver of a patient who had declined DT LVAD. Throughout the interviews, the overarching theme was that considering a DT LVAD is a complex decision-making process.

    Additionally, three dialectical tensions emerged:
    1) the stark decision context, with tension between hope and reality;
    2) the challenging decision process, with tension between wanting loved ones to live and wanting to respect loved ones’ wishes; and
    3) the downstream decision outcome, with tension between gratitude and burden.

    Medical Research: What should clinicians and patients take away from your report?

    Response: Several interventions should be considered for caregivers of patients considering DT LVAD.

    First, in order to better prepare caregivers for the burdens of DT LVAD, LVAD programs should continue to invite caregivers to participate in the decision-making process. This helps to address caregivers’ concerns and works to further engage them as active participants.

    Second, DT LVAD caregiver-specific tools and resources should be developed to outline responsibilities and the impact on the caregiver’s life.

    Third, providing caregivers with tools such as a decision aid may help to manage expectations and relieve the potential for post-decision caregiver burden. It is important for programs to normalize the ambivalence felt by caregivers by informing them that others have experienced this as a very complex decision.

    Fourth, ongoing caregiver support groups, separate from patient support groups, can assist in empowering caregivers as well as validating feelings and concerns.

    Medical Research: What recommendations do you have for future research as a result of this study?

    Response: Future work surrounding caregivers of patients considering DT LVAD should explore the decision process prospectively. Additionally, future studies should investigate the potential correlations between caregivers and their propensity toward certain tensions (e.g. which characteristics make caregivers more likely to have decision regret). This would lend itself to identifying caregivers who would benefit from tailored caregiver support or interventions, with some caregivers potentially needing no interventions at all.

    Citation:

    ACC15 Abstract 318: Caregiver Experiences with Decision Making in Destination Therapy Left Ventricular Assist Devices: A Qualitative Study

    Colleen K McIlvennan, Jacqueline Jones, Larry A Allen, JoAnn Lindenfeld
    Carolyn Nowels, Keith M Swetz and Daniel D Matlock

  2. Australians Develop First Bionic Heart

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    This world-first bionic heart works without a pulse
    Human transplants are expected from 2018.
    BEC CREW   11 MAR 2015
    Australian researchers have invented a new type of bionic heart that pumps blood around the body without a pulse. Named BiVACOR, the device has been successfully implanted in a sheep, and works so well, researchers are hoping to run human trials in just three years. Not only does the device last for up to a decade, but it’s smaller, and less susceptible to wear and tear than current artificial hearts. “There were other devices that were quite large, and they also would break quite easily,” one of the team Daniel Timms, formerly from the Queensland University of Technologytold Jorge Branco at The Brisbane Times. “And the reason they would break is they would have a sac, so if you’re beating them billions of times per year, they’re going to break.”

    BiVACOR is a relatively simple device, made from two titanium centrifugal impellers – or discs – placed on a single rotor. These discs spin together at 2,000 revolutions per minute to smoothly push incoming blood through the other end of the device, which is “a significant departure from traditional pulse-based designs, which included balloon-like sacs to pump blood”, says Branco. Because the device contains just one moving part – the rotating discs in the middle – there’s very little in it that can wear down and malfunction. The device was transplanted into a live sheep in January, and so far, so good. Just a little titanium disc spinning inside, keeping the sheep alive, most importantly, and also perfectly healthy. Here’s how it works:

    “We’ve now shown that the device works. This idea is viable. Now it’s a matter of making it robust and reliable so that it works in a patient,” Timms told Branco. “The time frame is three to five years before it could be ready for humans. Proving the concept was the first real hurdle. There are many to go from here but we’re confident we have the collaborative team to take it to that next level.”

    With heart failure affecting 300,000 Australians at any given time and 1.1 million people across the US and Europe, this is pretty exciting. Especially when you think about how just 4,000 donor hearts are available globally each year. We need something like this. Let’s see what the clinical trials bring.

  3. Could LVAD’s Be Used to Prevent Heart Failure? One Study Says Maybe!

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    Lvad helping heart failure

     

    There is evidence that use of the #LVAD could actually help prevent heart failure.

    A new study led by UT Southwestern Medical Center researchers suggests that the long-term use of left ventricular assist devices(LVAD) by patients who suffer from heart failure issues might induce the regeneration of heart muscles, as it prevents oxidative damage thanks to a cell-regulator mechanism.

    The study was published in the Journal of the American College of Cardiology.

    LVADs are devices implanted in patients awaiting heart transplants; they are mechanical pumps that act as substitutes for the damaged heart, pumping blood throughout the body.

    Dr. Hesham Sadek analyzed DNA markers of damage and cell proliferation in 10 patients, assessing them in pre- and post LVAD situations. The team based their study on previous data that demonstrated the capacity of newborn mice hearts to regenerate through activation of cell division. In this project, researchers showed that by assisting the damaged heart through LVADs usage, the oxidative stress of heart muscle cells would be alleviated.

    Dr. Sadek commented in a press release: “We looked at markers of what is called the DNA damage response in cardiomyocytes (heart-muscle cells) of these patients. The response is composed of a cascade of proteins that is activated in response to DNA damage and in turn shuts off the ability of cardiomyocytes to divide. We found that patients who were on LVAD for more than six months had significantly decreased levels of DNA damage response.”

    The research team found that those who used LVADs for six or more months had a 3-times higher rate of cardiomyocyte proliferation.

    “This result shows that patients with mechanical assist devices have the ability to make their muscle cells divide. And the obvious question now is, ‘Are these hearts regenerating? Could LVADs be used as a cure for heart failure?’” said Dr. Sadek.

     Dr. Pradeep Mammen, Associate Professor of Internal Medicine at UT Southwestern and co-senior author of the study, added, “Putting in a mechanical pump rests the heart and apparently sends a signal to make new heart cells.  This is the first time that this phenomenon has been shown to occur in human heart failure.”

     It is estimated that 6 million Americans live with high risk of heart failure, according to the American Heart Association. This incidence is expected to increase over the next 2 decades as the population ages and available treatments improve survival rates.

    “This is an exciting advance. We have a long way to go, but hopefully this study will be an important first step (…),”concluded Dr. Mark Drazner, Professor of Internal Medicine and Medical Director of the Heart Failure, LVAD, and Cardiology Transplant Program.

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