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Guha, Ashrith, Bashar Hannawi, Ana S. Cruz-Solbes, Duc T. Nguyen, Brian A. Bruckner, Barry Trachtenberg, Edward A. Graviss, et al. "Implication of Ventricular Assist Devices in Extracorporeal Membranous Oxygenation Patients Listed for Heart Transplantation." Journal of Clinical Medicine 8, no. 5 (April 26, 2019): 572. http://dx.doi.org/10.3390/jcm8050572.
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The new allocation criteria classify patients on veno-arterial extracorporeal membranous oxygenation (VA-ECMO) as the highest priority for receiving orthotopic heart transplantation (OHT) especially if they are considered not candidates for ventricular assist devices. The outcomes of patients who receive ventricular assist devices (VADs) after being listed for heart transplantation with VA-ECMO is unknown. We analyzed 355 patients listed for OHT with VA-ECMO from the United Network for Organ Sharing database from 2006 to 2014. Univariate and multivariate Cox proportional-hazards models were used to determine the contribution of prognostic variables to the outcome. Thirty-three patients (9.3%) received VADs (15 dischargeable, 7 non-dischargeable VADs). The VAD and non-VAD groups had similar listing characteristics except that the VAD group were more likely to have non-ischemic cardiomyopathy (48.5% vs. 25.2%), and less likely to be obese (6.1% vs. 25.2%) or have a history of prior organ transplant (3% vs. 31.1%). Patients who underwent VAD implantation had more days on the list (median 189 vs. 14 days) compared to the non-VAD group. Amongst the patients who had VADs, (25/33) 75.5% patients were subsequently transplanted with similar post-transplant survival compared to the non-VAD group (72% vs. 60.5%; p = 0.276). Predictors of one-year post-transplant mortality included panel reactive antibodies (PRA) class I ≥ 20%, recipient smoking history, increased serum creatinine and total bilirubin. Therefore, a small proportion of patients listed for transplantation with VA ECMO undergo VAD implantation. Their waitlist survival is better than non-VAD group but with similar post-transplant survival.
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Wells, Chris L. "Physical Therapist Management of Patients With Ventricular Assist Devices: Key Considerations for the Acute Care Physical Therapist." Physical Therapy 93, no. 2 (February 1, 2013): 266–78. http://dx.doi.org/10.2522/ptj.20110408.
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This article provides an overview of the utilization of ventricular assist devices (VADs), reviews the common features of VADs and management of VAD recipients, discusses clinical considerations in the rehabilitation process, and describes the role of the acute care physical therapist in the care of VAD recipients. With more than 5 million people in the United States with heart failure, and with a limited ability to manage the progressive and debilitating nature of heart failure, VADs are becoming more commonplace. In order to prescribe a comprehensive and effective plan of care, the physical therapist needs to understand the type and function of the VADs and the goals of the VAD program. The goals for the physical therapist are: (1) to deliver comprehensive rehabilitation services to patients on VAD support, (2) to develop an understanding of the role of functional mobility in recovery, and (3) to understand how preoperative physical function may contribute to the VAD selection process. The acute care physical therapist has an increasing role in providing a complex range of rehabilitation services, as well as serving as a well-educated resource to physical therapists across the health care spectrum, as more VAD recipients are living in the community.
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Yun, Soo Young, Young Jin Heo, Hae Woong Jeong, Jin Wook Baek, Hye Jung Choo, Jung Hwa Seo, Sung Tae Kim, Ji Young Lee, and Sung Chul Jin. "Spontaneous intracranial vertebral artery dissection with acute ischemic stroke: High-resolution magnetic resonance imaging findings." Neuroradiology Journal 31, no. 3 (March 22, 2018): 262–69. http://dx.doi.org/10.1177/1971400918764129.
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Background Acute ischemic stroke (AIS) more frequently develops in patients with intracranial vertebral artery dissection (VAD) than extracranial VAD, and is associated with possible poor clinical outcomes. The aim of this study is to compare high-resolution magnetic resonance imaging (HR-MRI) findings and clinical features of VAD with and without AIS. Methods Twenty-nine lesions from 27 patients (15 male and 12 female patients; age range = 28–73 years) who underwent diffusion MRI and 3T HR-MRI within seven days were included. We classified VAD according to the presence of AIS lesions on diffusion MRI. Clinical features and HR-MRI findings (angiographic patterns, presence of double lumen sign, dissecting flap, posterior inferior cerebellar artery involvement, remodeling index, length of affected vessels, T1-signal intensity, area of intramural hematoma, and grades and patterns of vessel wall enhancement) were evaluated. Results Thirteen VADs with AIS and 16 without AIS were included. There were no significant differences in the clinical parameters (sex, age, risk factors, symptoms). More VADs with AIS presented as a steno-occlusive pattern than VADs without AIS. More VADs without AIS presented with aneurysmal dilation, larger mean remodeling index and longer mean length than VADs with AIS. Presence of intramural hematoma, T1-iso-signal intensity of intramural hematoma and contrast enhancement were significantly more common in VADs with AIS than without AIS. Conclusions Our study showed some differences in HR-MRI comparing intracranial VAD patients with and without AIS. Differing findings may facilitate a better understanding of intracranial VAD and risk assessment of AIS in these patients.
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Craven, Claudia L., Paul Gissen, Rebecca Bower, Laura Lee, Kristian Aquilina, and Dominic N. P. Thompson. "A survival analysis of ventricular access devices for delivery of cerliponase alfa." Journal of Neurosurgery: Pediatrics 29, no. 1 (January 1, 2022): 115–21. http://dx.doi.org/10.3171/2021.7.peds21129.
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OBJECTIVE Late infantile neuronal ceroid lipofuscinosis type 2 (CLN2) is a rare autosomal recessive disease caused by tripeptidyl peptidase 1 enzyme deficiency. At the authors’ center, the medication cerliponase alfa is administered every 2 weeks via the intracerebroventricular (ICV) route. This requires the placement of a ventricular access device (VAD) or reservoir and frequent percutaneous punctures of this device over the child’s lifetime. In this study, the authors audited the longevity and survival of these VADs and examined the causes of device failure. METHODS A single-center survival analysis of VAD insertions and revisions (January 2014 through June 2020) was conducted. All children received cerliponase alfa infusions through a VAD. Patient characteristics and complications were determined from a prospectively maintained surgical database and patient records. For the VAD survival analysis, the defined endpoint was when the device was removed or changed. Reservoir survival was assessed using Kaplan-Meier curves and the log-rank (Cox-Mantel) test. RESULTS A total of 17 patients had VADs inserted for drug delivery; median (range) age at first surgery was 4 years 4 months (1 year 8 months to 15 years). Twenty-six VAD operations (17 primary insertions and 9 revisions) were required among these 17 patients. Twelve VAD operations had an associated complication, including CSF infection (n = 6) with Propionibacterium and Staphylococcus species being the most prevalent organisms, significant surgical site swelling preventing infusion (n = 3), leakage/wound breakdown (n = 2), and catheter obstruction (n = 1). There were no complications or deaths associated with VAD insertion. The median (interquartile range) number of punctures was 59.5 (7.5–82.0) for unrevised VADs (n = 17) versus 2 (6–87.5) for revised VADs (n = 9) (p = 0.70). The median survival was 301 days for revisional reservoirs (n = 9) versus 2317 days for primary inserted reservoirs (n = 17) (p = 0.019). CONCLUSIONS In the context of the current interest in intrathecal drug delivery for rare metabolic disorders, the need for VADs is likely to increase. Auditing the medium- to long-term outcomes associated with these devices will hopefully result in their wider application and may have potential implications on the development of new VAD technologies. These results could also be used to counsel parents prior to commencement of therapy and VAD implantation.
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Shlobin, Nathan A., Hooman A. Azad, Akash Mitra, Nikil Prasad, Michael B. Cloney, Benjamin S. Hopkins, Babak S. Jahromi, Matthew B. Potts, and Nader S. Dahdaleh. "Characteristics and Predictors of Outcome of Pseudoaneurysms Associated With Vertebral Artery Dissections: A 310-Patient Case Series." Operative Neurosurgery 20, no. 5 (January 15, 2021): 456–61. http://dx.doi.org/10.1093/ons/opaa464.
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Abstract BACKGROUND Vertebral artery dissections (VADs) are a common cause of stroke in young patients and can result in various secondary effects, including pseudoaneurysm formation. OBJECTIVE To identify differences in predisposing factors and outcomes for VADs with and without concomitant pseudoaneurysms. METHODS We retrospective chart reviewed patients who presented to our institution at the time of VAD with at least a 3-mo clinical follow-up. Demographics, VAD characteristics, treatment, and outcomes represented as modified Rankin scale (mRS) scores were collected. RESULTS Of 310 patients with a VAD included in this study, 301 patients had an identified pseudoaneurysm status, with 54 pseudoaneurysm-associated VADs and 247 VADs not associated with pseudoaneurysm. VAD patients with associated pseudoaneurysms were more likely to be female (P < .004), have bilateral VADs (P < .001), and have fewer vertebral artery segments affected (P = .018), and less likely to have stroke (P < .008) or occlusion of the vertebral artery (P < .001). There was no difference in the proportion of patients treated with antiplatelet agents (P = .12) or anticoagulants (P = .27) between the groups. VAD patients with associated pseudoaneurysms were more likely to have a higher mRS at 3-mo follow-up (P = .044) but not discharge (P = .18) or last follow-up (P = .05). VAD patients with pseudoaneurysms were equally likely to have resolution of occlusion (P = .40) and stenosis (P = .19). CONCLUSION Demographics and clinical and radiological characteristics of VADs associated with pseudoaneurysms are different from those without associated pseudoaneurysms. Vertebral artery dissections with concomitant pseudoaneurysms are neither associated with worse functional nor radiographic outcomes.
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Masuko, Yu, Nobuyuki Shimizu, Ryosuke Suzuki, Jun Suenaga, Kagemichi Nagao, Fukutaro Ohgaki, and Tetsuya Yamamoto. "Reconstructive embolization for contralateral vertebral artery dissecting aneurysm that developed after internal trapping of ruptured vertebral artery dissection: A case report and literature review." Surgical Neurology International 13 (March 31, 2022): 124. http://dx.doi.org/10.25259/sni_19_2022.
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Background: It is not well-known that contralateral vertebral artery dissecting aneurysms (VADA) may be newly revealed after parental artery occlusion for unilateral VADA. However, the optimal treatment strategies and perioperative management have not been established. In this report, we present the case of a patient who required reconstructive embolization in the subacute stage for contralateral VADA developed after endovascular internal trapping of the ruptured VADA. Case Description: A 61-year-old man developed subsequent disturbance of consciousness. Head CT showed a diffuse and symmetrical SAH. 3DCT revealed a fusiform aneurysm of the left intracranial vertebral artery with bleb formation. We performed emergency endovascular parent artery occlusion of the left vertebral artery. A digital subtraction angiography on postoperative day 16 showed continued occlusion of the left VA, and a fusiform aneurysm was noted at the right VA. We performed reconstructive embolization and the patient eventually recovered with minimal persistent symptoms. Conclusion: Since the outcomes of contralateral VAD complicated by infarction or hemorrhage are poor, and most cases develop within 7–14 days after endovascular internal trapping for unilateral VAD, performing bilateral radiographic reinspection within this time frame is recommended for early detection and preventive treatment of possible contralateral VADs.
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Ariza-Solé, Albert, José C. Sánchez-Salado, Fabrizio Sbraga, Daniel Ortiz, José González-Costello, Arnau Blasco-Lucas, Oriol Alegre, et al. "The role of perioperative cardiorespiratory support in post infarction ventricular septal rupture-related cardiogenic shock." European Heart Journal: Acute Cardiovascular Care 9, no. 2 (December 10, 2018): 128–37. http://dx.doi.org/10.1177/2048872618817485.
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Background: Current guidelines recommend emergency surgical correction in patients with post infarction ventricular septal rupture (PIVSR), but patients with multiorgan failure are commonly managed conservatively because of high surgical risk. We assessed characteristics and outcomes of operated PIVSR patients with or without the use of short-term ventricular assist devices (ST-VADs). We also assessed the impact of a ST-VAD on the performance of surgery Methods: We retrospectively analysed all consecutive patients with PIVSR between January 2004 and May 2017. Baseline clinical characteristics, use of ST-VAD and performance of surgery during admission were assessed. The main outcome measured was in-hospital mortality. Results: A total of 28 patients were included. Mean age was 69.2 years. Most patients (20/28, 71.4%) underwent surgical repair. ST-VADs were used in 11/28 patients (39.3%). This percentage progressively increased across the study period, from 22.2% (2/9) in 2004–2011 to 58.3% (7/12) in 2015–2017 ( p=0.091). Patients undergoing ST-VAD use had poorer INTERMACS status, higher values of creatinine, lactate and alanine aminotransferase and lower left ventricular ejection fraction as compared with operated patients without support. In-hospital mortality did not differ according to the use of ST-VADs in operated patients (27.3% without ST-VAD vs. 22.2% with ST-VAD, p=0.604). All five patients undergoing early preoperative venoarterial extracorporeal membrane oxygenator support and delayed surgery survived at hospital discharge. Conclusions: ST-VAD use increased in patients with PIVSR. Despite a higher risk profile in operated patients undergoing ST-VAD use, mortality was not significantly different in these patients. Early preoperative venoarterial extracorporeal membrane oxygenation should be considered for very high risk PIVSR patients.
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Standing, Holly C., Catherine Exley, Guy A. MacGowan, and Tim Rapley. "‘We’re like a gang, we stick together’: experiences of ventricular assist device communities." European Journal of Cardiovascular Nursing 17, no. 5 (January 19, 2018): 399–407. http://dx.doi.org/10.1177/1474515118754738.
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Background: Ventricular assist devices (VADs) are a relatively new development in the management of advanced heart failure. In the UK, VAD recipients comprise a unique group of less than 200 patients. This is the first paper to explore the experience of VAD communities, the extent to which communities are developed around the device, and how these influence the experience of living with the VAD. Methods: Qualitative interviews were conducted with 20 VAD recipients (implanted as a bridge to transplantation), 11 interviews also included the VAD recipients’ partners. Interpretive phenomenology was employed as the theoretical basis guiding the analysis of the interviews. Results: Four key themes emerged from the data: the existence of VAD communities; experiential knowledge and understanding; social comparisons; and the impacts of deaths within the VAD community. Many of the interviewees valued the VAD communities and the relationships they had formed with fellow recipients. The beneficial impacts of the VAD communities included offering recently implanted patients a realistic view of what to expect from life with a VAD; this could aid them in accepting and adapting to the changes imparted by the device. However, negative impacts of the VAD communities were also reported, in particular following deaths within the group, which were a source of distress for many of the interviewees. Conclusions: In general, the VAD communities appeared to be a beneficial source of support for the majority of interviewees. Consideration should be given to how these communities could be supported by clinicians.
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Newington, Dash F. T., Fabrizio De Rita, Alan McCheyne, and Claire Louise Barker. "Pediatric Ventricular Assist Device Implantation: An Anesthesia Perspective." Seminars in Cardiothoracic and Vascular Anesthesia 25, no. 3 (March 16, 2021): 229–38. http://dx.doi.org/10.1177/1089253221998546.
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Background Ventricular assist devices (VADs) are increasingly being implanted in children, yet there is little literature to guide anesthetic management for these procedures. Aims To describe the pediatric population presenting for VAD implantation and the anesthetic management these patients receive. To compare (a) children under and over 12 months of age and (b) children with and without congenital heart disease. Methods Retrospective review of patients aged 0 to 17 years who underwent VAD implantation at a single center between 2014 and 2019. Results Seventy-seven VADs were implanted in 68 patients (46 left VADs, 24 biventricular VADs, 6 right VADs, and 1 univentricular VAD). One procedure was abandoned. Preoperatively, 20 (26%) patients were supported with extracorporeal membrane oxygenation and 57 (73%) patients were ventilated. Intraoperative donor blood products were required in 74 (95%) cases. Postimplantation inotropic support was required in 66 (85%) cases overall and 46 (100%) patients receiving a left VAD. Infants under 12 months were more likely to require preoperative extracorporeal membrane oxygenation (42% vs 19%), have femoral venous access (54% vs 28%), receive an intraoperative vasoconstrictor (42% vs 24%), and have delayed sternal closure (63 vs 22%). Mortality was higher in patients under 12 months (25% vs 19%) and in patients with congenital heart disease (25% vs 20%). Conclusions Children undergoing VAD implantation require high levels of preoperative organ support, high-dose intraoperative inotropic support, and high-volume blood transfusion. Children under 12 months and those with congenital heart disease are particularly challenging for anesthesiologists and have worse overall outcomes.
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Strueber, Martin. "VAD." JACC: Heart Failure 4, no. 12 (December 2016): 971–73. http://dx.doi.org/10.1016/j.jchf.2016.10.007.
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Plokhikh, D. A., D. E. Beglov, and K. A. Kovalkov. "DIAGNOSTIC CRITERIA FOR VISCEROABDOMINAL DISPROPORTION SYNDROME IN GASTROSCHISIS." Pediatria. Journal named after G.N. Speransky 100, no. 6 (December 13, 2021): 53–59. http://dx.doi.org/10.24110/0031-403x-2021-100-6-53-59.
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The objectives of this study were to determine the frequency and search for additional criteria for the diagnosis of visceroabdominal disproportion syndrome (VADS) in newborns with gastroschisis. Materials and methods of research: prospective controlled observational cross-sectional analytical study was carried out in 61 newborns with gastroschisis, admitted from June 2009 to July 2021. To search for the most significant factors indicating the presence of VADS, the following parameters were recorded in the studied patients: the size of the defect in the anterior abdominal wall, the composition of eventrated organs, the presence of a conglomerate of intestinal loops, the diameter of the intestinal tube, the thickness of the intestinal wall, the degree of visceroabdominal disproportion (VAD). Results: VAD was detected in 50 (82%) newborns with gastroschisis. In 10 (17%) cases, VAD was mild, in 27 (44%) – moderate, and in 13 (21%) patients – severe. A moderate direct relationship was found between the size of the anterior abdominal wall defect (r=0.29, p=0.022), intestinal tube diameter (r=0.56; p=0.001) and the severity of VAD. There was a strong direct correlation between the thickness of the intestinal wall, and the frequency and severity of VAD (r=0.93, p=0.001). A direct association was found between the presence of a conglomerate of intestinal loops in the eventrated organs and the frequency of VAD (p=0.002). There was no statistically significant relationship between the number of eventrated anatomical structures with the frequency and degree of VAD (p=0.36). Conclusion: to determine VADS, it is advisable to diagnose the following pathological conditions in patients with gastroschisis: thickening of the intestinal wall, dilatation of the intestinal tube, the presence of a conglomerate of tightly welded eventrated organs, the severity of which is directly proportional to the degree of disproportion.
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Friedman, Emily, and Molly McMahon. "TO VAD OR NOT TO VAD." Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care 3, no. 1 (June 2014): 238–45. http://dx.doi.org/10.1177/2327857914031039.
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As part of its Healthy Aging & Independent Living (HAIL) initiative, Mayo Clinic Center for Innovation (CFI) examined the patient experience regarding the decision to receive a ventricular assistive device (VAD) implant, and patients’ quality of life after the surgery. As health care technology continues to develop, more people will be living longer, fuller lives with the assistance of wearable/implantable medical devices such as the VAD. This case study examined and made recommendations on ways for the Mayo Clinic VAD Committee to improve the program.
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Webster, J. H., S. Merali, L. Adcock, N. Y. Raval, and D. A. Dean. "799 VAD Competent or VAD Aware?" Journal of Heart and Lung Transplantation 31, no. 4 (April 2012): S272. http://dx.doi.org/10.1016/j.healun.2012.01.816.
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Schwientek, Patrick, Peter Ellinghaus, Sonja Steppan, Donatella D'Urso, Michael Seewald, Astrid Kassner, Ramona Cebulla, et al. "Global gene expression analysis in nonfailing and failing myocardium pre- and postpulsatile and nonpulsatile ventricular assist device support." Physiological Genomics 42, no. 3 (August 2010): 397–405. http://dx.doi.org/10.1152/physiolgenomics.00030.2010.
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Mechanical unloading by ventricular assist devices (VAD) leads to significant gene expression changes often summarized as reverse remodeling. However, little is known on individual transcriptome changes during VAD support and its relationship to nonfailing hearts (NF). In addition no data are available for the transcriptome regulation during nonpulsatile VAD support. Therefore we analyzed the gene expression patterns of 30 paired samples from VAD-supported (including 8 nonpulsatile VADs) and 8 nonfailing control hearts (NF) using the first total human genome array available. Transmural myocardial samples were collected for RNA isolation. RNA was isolated by commercial methods and processed according to chip-manufacturer recommendations. cRNA were hybridized on Affymetrix HG-U133 Plus 2.0 arrays, providing coverage of the whole human genome Array. Data were analyzed using Microarray Analysis Suite 5.0 (Affymetrix) and clustered by Expressionist software (Genedata). We found 352 transcripts were differentially regulated between samples from VAD implantation and NF, whereas 510 were significantly regulated between VAD transplantation and NF (paired t-test P < 0.001, fold change ≥1.6). Remarkably, only a minor fraction of 111 transcripts was regulated in heart failure (HF) and during VAD support. Unsupervised hierarchical clustering of paired VAD and NF samples revealed separation of HF and NF samples; however, individual differentiation of VAD implantation and VAD transplantation was not accomplished. Clustering of pulsatile and nonpulsatile VAD did not lead to robust separation of gene expression patterns. During VAD support myocardial gene expression changes do not indicate reversal of the HF phenotype but reveal a distinct HF-related pattern. Transcriptome analysis of pulsatile and nonpulsatile VAD-supported hearts did not provide evidence for a pump mode-specific transcriptome pattern.
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Weichsel, Johannes, Benito Baldauf, Hendrik Bonnemeier, Ernest W. Lau, Sven Dittrich, and Robert Cesnjevar. "Eradication of Ventricular Assist Device Driveline Infection in Paediatric Patients with Taurolidine." Journal of Cardiovascular Development and Disease 9, no. 1 (January 10, 2022): 18. http://dx.doi.org/10.3390/jcdd9010018.
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Ventricular assist devices (VADs) are used to provide mechanical circulatory support to patients with end-stage heart failure. The driveline connecting the external power source to the pump(s) of the intra-corporal VAD breaches the protective skin barrier and provides a track for microbes to invade the interior of the patient’s body. Driveline infection constitutes a major and potentially fatal vulnerability of VAD therapy. Driveline infection cannot traditionally be salvaged and requires the extraction of the entire VAD system. We report here the successful eradication of a VAD driveline infection with a taurolidine-containing antimicrobial solution used for preventing the infection of cardiac implantable electronic devices. If replicated in more cases, the novel treatment concept described here may provide a valuable alternative management strategy of salvage rather than explantation for VAD driveline infection.
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Roberts, Scott C., Jonathan D. Rich, Duc T. Pham, Rebecca Harap, and Valentina Stosor. "1177. A Spectrum of Infectious Complications in Continuous-Flow Ventricular Assist Devices: A Single-Center Longitudinal Cohort." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S421—S422. http://dx.doi.org/10.1093/ofid/ofz360.1040.
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Abstract Background Infections remain a frequent complication of patients (patients) with ventricular assist devices (VAD). We evaluated the epidemiology and outcomes of VAD infections at our center over a 10-year period. Methods We performed a retrospective cohort study of continuous-flow VAD recipients from July 2008-September 2018. VAD-specific and -related infections were characterized according to 2013 ISHLT definitions. Summary and comparative statistics were performed using IBM® SPSS Statistics version 25.0. Results 433 VADs were implanted into 375 patients. A total of 86 VAD infections occurred in 79 patients, with a mean incidence of 0.19 episodes/VAD and 0.20 episodes/pt. Patients with infections were predominantly male (73.3%) and Caucasian (54.6%), and had mean age of 52.7 years, nonischemic cardiomyopathy (58.1%), and VAD as bridge to transplant (53.5%, n = 46). Types of VAD included 43.0% axial (n = 37) and 57.0% centrifugal flow (n = 49). 78% of patients with infections were colonized with at least one multidrug-resistant organism (MDRO) such as MRSA (29%), VRE (73%), and ESBL (24%). Notably, 15% of infections (n = 13) occurred within 60 d of VAD implantation, with mean time to onset 36 d (5–60 d) post-VAD. Early infections (<60d) involved driveline exit site (DLES) (n = 4), pocket (n = 3), and pump (n = 7) with 7 VAD-related blood stream infections (BSI), 6 infective endocarditis (IE), and 2 mediastinitis. Early infections involved Gram-positive (GP) bacteria (84.6%, n = 11), Gram-negatives (GN) (45.5%, n = 5), anaerobes (23.1%, n = 3), fungi (30.8%, n = 4), MDRO (61.5%, n = 8) and 32 pathogens (69.2%, n = 9). 85% of infections occurred late (n = 73) with mean time to onset 338 d (69–1215 d). In late infections (>60d), impacted sites included DLES (n = 38), pocket (n = 7), and pump (n = 40), with 42 BSI, 36 IE, and 2 mediastinitis. Pathogens were 68.5% GP (n = 50), 37.0% GN (n = 27), 2.7% anaerobes (n = 2), 2.7% fungi (n = 2), 17.8% MDRO (n = 13), and 26.0% polymicrobial (n = 19). Conclusion In this longitudinal retrospective cohort of patients supported with VADs, a majority of infections occurred >9 months post-implantation. GP pathogens predominated at all time-points. GN bacteria, including MDROs, anaerobes, and fungi are increasingly encountered. The vast majority of patients were colonized with ³1 MDRO during the course of VAD implantation. Disclosures All authors: No reported disclosures.
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Ruden, Serena A. S. Von, Margaret A. Murray, Jennifer L. Grice, Amy K. Proebstle, and Karen J. Kopacek. "The Pharmacotherapy Implications of Ventricular Assist Device in the Patient With End-Stage Heart Failure." Journal of Pharmacy Practice 25, no. 2 (March 5, 2012): 232–49. http://dx.doi.org/10.1177/0897190011431635.
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Advances in mechanical circulatory support, such as the use of ventricular assist devices (VADs), have become a means for prolonging survival in end-stage heart failure (HF). VADs decrease the symptoms of HF and improve quality of life by replacing some of the work of a failing heart. They unload the ventricle to provide improved cardiac output and end-organ perfusion, resulting in improvement in cardiorenal syndromes and New York Heart Association functional class rating. VADs are currently used as a bridge to heart transplantation, a bridge to recovery of cardiac function, or as destination therapy. Complications of VAD include bleeding, infections, arrhythmias, multiple organ failure, right ventricular failure, and neurological dysfunction. Patients with VAD have unique pharmacotherapeutic requirements in terms of anticoagulation, appropriate antibiotic selection, and continuation of HF medications. Pharmacists in acute care and community settings are well prepared to care for the patient with VAD. These patients require thorough counseling and follow-up with regard to prevention and treatment of infections, appropriate levels of anticoagulation, and maintenance of fluid balance. A basic understanding of this unique therapy can assist pharmacists in attending to the needs of patients with VAD.
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Li, Yuan, Hongyu Wang, Yifeng Xi, Anqiang Sun, Xiaoyan Deng, Zengsheng Chen, and Yubo Fan. "A New Mathematical Numerical Model to Evaluate the Risk of Thrombosis in Three Clinical Ventricular Assist Devices." Bioengineering 9, no. 6 (May 27, 2022): 235. http://dx.doi.org/10.3390/bioengineering9060235.
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(1) Background: Thrombosis is the main complication in patients supported with ventricular assist devices (VAD). Models that accurately predict the risk of thrombus formation in VADs are still lacking. When VADs are clinically assisted, their complex geometric configuration and high rotating speed inevitably generate complex flow fields and high shear stress. These non-physiological factors can damage blood cells and proteins, release coagulant factors and trigger thrombosis. In this study, a more accurate model for thrombus assessment was constructed by integrating parameters such as shear stress, residence time and coagulant factors, so as to accurately assess the probability of thrombosis in three clinical VADs. (2) Methods: A mathematical model was constructed to assess platelet activation and thrombosis within VADs. By solving the transport equation, the influence of various factors such as shear stress, residence time and coagulation factors on platelet activation was considered. The diffusion equation was applied to determine the role of activated platelets and substance deposition on thrombus formation. The momentum equation was introduced to describe the obstruction to blood flow when thrombus is formed, and finally a more comprehensive and accurate model for thrombus assessment in patients with VAD was obtained. Numerical simulations of three clinically VADs (CH-VAD, HVAD and HMII) were performed using this model. The simulation results were compared with experimental data on platelet activation caused by the three VADs. The simulated thrombogenic potential in different regions of MHII was compared with the frequency of thrombosis occurring in the regions in clinic. The regions of high thrombotic risk for HVAD and HMII observed in experiments were compared with the regions predicted by simulation. (3) Results: It was found that the percentage of activated platelets within the VAD obtained by solving the thrombosis model developed in this study was in high agreement with the experimental data (r² = 0.984), the likelihood of thrombosis in the regions of the simulation showed excellent correlation with the clinical statistics (r² = 0.994), and the regions of high thrombotic risk predicted by the simulation were consistent with the experimental results. Further study revealed that the three clinical VADs (CH-VAD, HVAD and HMII) were prone to thrombus formation in the inner side of the secondary flow passage, the clearance between cone and impeller, and the corner region of the inlet pipe, respectively. The risk of platelet activation and thrombus formation for the three VADs was low to high for CH-VAD, HVAD, and HM II, respectively. (4) Conclusions: In this study, a more comprehensive and accurate thrombosis model was constructed by combining parameters such as shear stress, residence time, and coagulation factors. Simulation results of thrombotic risk received with this model showed excellent correlation with experimental and clinical data. It is important for determining the degree of platelet activation in VAD and identifying regions prone to thrombus formation, as well as guiding the optimal design of VAD and clinical treatment.
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Chernecky, Cynthia, Denise Macklin, Katherine Nugent, and Jennifer Waller. "Potential Value of Vitamin E in Cancer Patients with Venous Access Devices." Journal of the Association for Vascular Access 13, no. 2 (June 1, 2008): 71–73. http://dx.doi.org/10.2309/java.13-2-4.
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Abstract Background: Vitamin E has antiplatelet, fibrinolytic and endotoxin properties that may help avoid the problems of occlusion or inability to withdraw blood from port VADs. Purpose: Disseminate information about the non-traditional therapeutic use of vitamin E associated with care of Venous Access Devices (VAD) in patients with cancer. Methodology: In-person focus groups. Sample of 22 cancer patients who had port Venous Access Devices (VAD). Findings: Fourteen percent (N = 3) of patients felt that taking vitamin E, 400 -800 IU per day orally, in capsule form, avoided the problems of occlusion or inability to withdraw blood from their current VAD. Practice Implications: The effects of vitamin E on occlusion and inability to withdraw blood in caring for patients who have port VADs, requires further investigation.
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Shah, Nirmish, Daniel Landi, Radhika Shah, Jennifer Rothman, and Courtney Thornburg. "Complications of Implantable Venous Access Devices In Patients with Sickle Cell Disease." Blood 116, no. 21 (November 19, 2010): 1649. http://dx.doi.org/10.1182/blood.v116.21.1649.1649.
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Abstract Abstract 1649 INTRODUCTION: Implantable venous access devices (VADs) are used in sickle cell disease (SCD) for patients with poor venous access to facilitate chronic blood transfusions and management of acute complications. Children and adults with chronic illnesses have high rates of VAD-related complications including bloodstream infection and thrombosis. Patients with SCD may be at higher risk given the presence of functional asplenia and evidence of a hypercoaguable state. The objective of this study was to define the frequency of VAD related bloodstream infections and thrombosis in adults and children with SCD. PATIENTS AND METHODS: We performed a single institution retrospective review of VAD placement in patients with SCD. Subjects were identified through the sickle cell clinic database and the Hospital Information System. Subjects were included if they had SCD, VAD placement between December 1, 1998 to December 1, 2009 and had completed at least 12 months of follow-up. VAD-related bloodstream infection was defined by positive blood culture and VAD-related thrombosis (deep vein thrombosis, superior vena cava syndrome, and pulmonary embolism without lower extremity thrombosis) was defined by imaging. Comparisons were made between pediatric and adult sickle cell patients using Student's t-test for continuous variables and Fisher's exact test was used to compare categorical variables; p<0.05 was considered significant. RESULTS: Of the greater than 800 sickle cell patients followed at our Comprehensive Sickle Cell Center, 32 subjects were eligible for inclusion (median age 20 years, range 1–59). There were 81 VAD placed (median 2.6 VAD per patient, range 1–7) with a total of 49268 catheter days (median 608, range 323–3999). The mean catheter lifespan in adults (1798 days ± 266) was significantly higher than pediatric patients (971 ± 328, p=0.039). There were a total of 66 VAD-related bloodstream infections (1.34 infections per 1000 catheter days) occurring in 17 of 32 (53%) subjects. Although not statistically significant, children had fewer VAD-related bloodstream infections (3 of 10; 30%) compared to adults (14 of 22; 64%, p=0.08). There were 24 catheter-related thromboses (0.49 thromboses per 1000 catheter days) occurring in 10 of 32 (41%) of subjects. Children also had fewer VAD-related thrombosis (1 of 10; 10%) compared to adults (9 of 22; 40%, p=0.08). The overall rates of infection and thrombosis per 1000 catheter days were not significantly different between adult and pediatric patients. CONCLUSION: In summary, we report a long lifespan and low rate of infection in the subjects who had VADs during the study period. Most concerning was a high proportion of adults with catheter-related thrombosis, which adds the burden of anticoagulation to patient management and put patients at risk for post-thrombotic syndrome. Potential lifespan of VADs, risk of bloodstream infection and thrombosis as well as its long-term consequences should be discussed with patients and families considering VAD placement. Disclosures: No relevant conflicts of interest to declare.
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Mason, John B., Maria A. Ramirez, Chona M. Fernandez, Regina Pedro, Tina Lloren, Lisa Saldanha, Megan Deitchler, and Eisele. "Effects on Vitamin A Deficiency in Children of Periodic High-Dose Supplements and of Fortified Oil Promotion in a Deficient Area of the Philippines." International Journal for Vitamin and Nutrition Research 81, no. 5 (September 1, 2011): 295–305. http://dx.doi.org/10.1024/0300-9831/a000077.
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Regular semi-annual distribution of high-dose (200,000 IU) vitamin A capsules (VACs) to children 1 - 5 years of age (previously identified as underweight), in Leyte Province, the Philippines, was compared to providing extra VACs to give three-monthly dosing, and to vitamin A-fortified cooking oil (VAFO) promotion (with continued VACs every 6 months). Serum retinol (SR) was measured at baseline and after 12 or 18 months (for VAFO). No sustained increase in SR was determined from the three-month VAC dosing regimen, and the prevalence of vitamin A deficiency (VAD) as assessed by SR (< 20 mcg / dL) remained around 30 % (in line with national survey estimates over the previous 15 years). The major difference found was that 18 months of VAFO (of which 9 months had sustained promotion) was associated with reducing the prevalence of VAD to < 10 %. The effective fortification and lack of effect of semi-annual VAC results are in line with previous studies; testing with dosing of VAC every three months is a new intervention. The results imply that promotion of fortified oil would reduce VAD in these conditions; whether it can replace or needs to be added to semi-annual VAC dosing remains to be determined. A phased changeover to reliance on fortified commodities (including oil) with careful monitoring of VAD trends is indicated.
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Hu, Jessica, Lauren Dutcher, Vasilios Athans, Shawn Binkley, Justin Harris, Sonal Patel, Stephen Saw, and Tiffany Lee. "622. Evaluation of Vascular Access Device Selection in Patients Discharged on Outpatient Parenteral Antimicrobial Therapy." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S413—S414. http://dx.doi.org/10.1093/ofid/ofab466.820.
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Abstract Background Selection of a vascular access device (VAD) is an important consideration for patients receiving outpatient parenteral antimicrobial therapy (OPAT). Midline catheters (MC) and peripherally inserted central catheters (PICC) are the most commonly placed VADs, with the former recommended by national guidelines to be used for durations no longer than two weeks. These recommendations, however, are based on limited data from heterogeneous populations. As such, we aim to further characterize VAD-associated complications specifically in patients receiving antimicrobials. Methods We conducted a retrospective cohort study that included adult patients discharged on OPAT with a newly inserted MC or PICC between January 2020 and August 2020. Patients with non-OPAT VAD indications were excluded. The primary outcome was the incidence of VAD-associated complications, which was further assessed by type and severity. The secondary outcome was time to complication. Multivariable Poisson regression was used to assess the association between VAD type and incidence of VAD-associated complications. Results A total of 190 encounters from 181 patients were included for analysis. Baseline demographics are detailed in Table 1. Despite a higher number of complications in the PICC group, rates per 1000 VAD days were not significantly different between VAD types (Table 2). Median time to first complication was 17 days in the overall cohort. Multivariable regression analysis showed those with a dermatologic history had a four-fold increased risk for VAD-associated complications (Table 3). VAD type was not independently associated with the risk of developing a complication. Conclusion Our results suggest that the development of VAD-associated complications was strongly associated with patients’ dermatologic history. To our knowledge, dermatologic history has not been previously identified as a risk factor for VAD-associated complications. Thorough assessment of patient-specific risk factors can inform optimal VAD selection for patients discharged on OPAT. Further studies are needed to assess the safety of MC for extended OPAT use. Disclosures All Authors: No reported disclosures
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Bäckström, Stina. "Vad är mat och vad är annat?" Norsk filosofisk tidsskrift 54, no. 04 (December 10, 2019): 220–31. http://dx.doi.org/10.18261/issn.1504-2901-2019-04-04.
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Joshi, Ravi V. "Ventricular Assist Devices in the ICU." ICU Director 4, no. 1 (December 26, 2012): 15–21. http://dx.doi.org/10.1177/1944451612470447.
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Since 2001, ventricular assist devices (VADs), total artificial hearts, and a growing number of devices have become increasingly more commonplace options to heart failure management and viable alternatives to heart transplantation. Cardiothoracic step-down and intensive care units will likely be managing more and more patients on mechanical circulation in the future. This review will briefly give an introduction to VAD function, types of VADs, the characteristics of VAD patients, and management issues in the ICU that may arise with these patients.
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Chestovich, Paul J., Murray H. Kwon, H. Gill Cryer, Areti Tillou, and Jonathan R. Hiatt. "Surgical Procedures for Patients Receiving Mechanical Cardiac Support." American Surgeon 77, no. 10 (October 2011): 1314–17. http://dx.doi.org/10.1177/000313481107701008.
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Mechanical cardiac support devices are used for patients with cardiopulmonary failure. We reviewed our institutional experience with noncardiac surgical procedures (NCPs) in patients supported by ventricular assist devices (VADs, n = 198) or extracorporeal membrane oxygenation (ECMO, n = 165) between July 1998 and June 2010. In total, 64 NCPs were performed in 55 VAD patients and 14 NCPs in 14 ECMO patients. Thirty-day mortality was higher for the VAD compared with the ECMO group (25 vs 86%; P < 0.001) and was greater for emergent compared with nonemergent procedures (58 vs 19%; P < 0.001). Excluding tracheostomy, no patients died within 30 days of a nonemergent procedure. Kaplan-Meier survival showed a trend toward worse survival after NCP in ECMO patients, but NCP did not alter survival in VAD patients. Fewer VAD patients were bridged to heart transplantation when NCP was required, and time from device implantation to transplant was significantly longer than for patients without NCP. In summary, this is the largest series of NCPs on VAD support and the only series on ECMO. Mortality is substantial for ECMO patients. Selected procedures can be performed safely in VAD patients but will delay heart transplantation.
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Paolucci, Helen, Benjamin Nutter, and Nancy M. Albert. "RN Knowledge of Vascular Access Devices Management." Journal of the Association for Vascular Access 16, no. 4 (December 1, 2011): 221–25. http://dx.doi.org/10.2309/java.16-4-4.
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Abstract Purpose: To explore the level of RNs knowledge of managing vascular access devices (VADs)- peripherally inserted central catheters (PICCs) and midline catheters, and to determine if nurse characteristics are associated with knowledge level. Background: Education of nursing staff about VAD management can improve quality of care and assure standards of practice are maintained. Review of Literature: Minimal research is available on nurses' knowledge of managing VAD catheters. Methods: Nurses working on a colo-rectal unit who frequently manage VADs in a large tertiary-care medical center voluntarily completed one anonymous, validated, 10-item survey of VAD management themes. Analysis included descriptive and correlational statistics. Results: Of 36 nurses, (97% female, 53% full time), mean VAD knowledge score was 8.1 ± 1.4 (81% mean sum score). Perceived general level of comfort in flushing PICCs (r=.35, P=0.04), using Alteplase with PICCs (r=.36, P=0.03) and changing dressings (r=.38; P=0.03) were associated with higher knowledge scores. Of 10 items, 4 resulted in scores below 80%: how fast a Midline can be used after insertion, first step in managing a PICC upon admission, steps in dealing with a withdrawal occlusion, and steps post interventional radiology PICC insertion; however, nurse characteristics were not associated with scores above or below 80%. Conclusions: Nurses working in the colo-rectal unit that frequently treat patients with VADs were generally knowledgeable about their management. Perceived nurse comfort in flushing a PICC, using Alteplase, and changing dressings were associated with higher knowledge. Implications for Practice: Nurses' impressions of comfort with VAD management should be regularly assessed by nurse managers to assure optimal knowledge.
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Hwang, Soojoong, Yu Gwang Jin, and Jong Won Shin. "Dual Microphone Voice Activity Detection Based on Reliable Spatial Cues." Sensors 19, no. 14 (July 11, 2019): 3056. http://dx.doi.org/10.3390/s19143056.
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Two main spatial cues that can be exploited for dual microphone voice activity detection (VAD) are the interchannel time difference (ITD) and the interchannel level difference (ILD). While both ITD and ILD provide information on the location of audio sources, they may be impaired in different manners by background noises and reverberation and therefore can have complementary information. Conventional approaches utilize the statistics from all frequencies with fixed weight, although the information from some time–frequency bins may degrade the performance of VAD. In this letter, we propose a dual microphone VAD scheme based on the spatial cues in reliable frequency bins only, considering the sparsity of the speech signal in the time–frequency domain. The reliability of each time–frequency bin is determined by three conditions on signal energy, ILD, and ITD. ITD-based and ILD-based VADs and statistics are evaluated using the information from selected frequency bins and then combined to produce the final VAD results. Experimental results show that the proposed frequency selective approach enhances the performances of VAD in realistic environments.
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Radics, Rudolf. "Vad figurativitás." Partitúra 16, no. 2 (February 18, 2022): 79–92. http://dx.doi.org/10.17846/pa.2021.16.2.79-92.
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Akanni, Olutosin J., Koji Takeda, Lauren K. Truby, Paul A. Kurlansky, Codruta Chiuzan, Jiho Han, Veli K. Topkara, et al. "EC-VAD." ASAIO Journal 65, no. 3 (2019): 219–26. http://dx.doi.org/10.1097/mat.0000000000000804.
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&NA;. "Debakev VAD." ASAIO Journal 44, no. 2 (March 1998): 52A. http://dx.doi.org/10.1097/00002480-199803000-00193.
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Nosé, Yukihiko. "Tele-VAD." Artificial Organs 21, no. 10 (November 12, 2008): 1055. http://dx.doi.org/10.1111/j.1525-1594.1997.tb00441.x.
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Beyersdorf, Friedhelm, Lea Nakamura, Christoph Benk, Michael Berchtold-Herz, Georg Trummer, Christian Schlensak, Claudia Heilmann, Ulrich Geisen, and Barbara Zieger. "Acquired von Willebrand syndrome in patients with ventricular assist device or total artificial heart." Thrombosis and Haemostasis 103, no. 05 (2010): 962–67. http://dx.doi.org/10.1160/th09-07-0497.
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SummaryUnexplained bleeding episodes are associated with ventricular assist devices (VAD) and can occur in part due to acquired von Willebrand syndrome (AVWS). AVWS is characterised by loss of high molecular weight (HMW) multimers of von Willebrand factor (VWF) and decreased ratios of collagen binding capacity and ristocetin cofactor activity to VWF antigen. Loss of multimers can occur as VWF is subjected to increased shear stress, which occurs in presence of VADs. We studied 12 patients who required mechanical support of their native heart for terminal cardiac insufficiency. Nine patients underwent placement of a VAD, while three underwent placement of a total artificial heart (TAH), which is connected directly to heart and large cardiac vessels without cannulas. Within one day of VAD implantation, four of five patients evaluated demonstrated loss of HMW multimers and impaired VWF function. AVWS was present within two weeks of implantation in eight of nine patients, and in all seven tested patients after ≥3 months. Patients with different VAD types developed varying severities of AVWS. After VAD ex-plantation, HMW multimers were detectable and VWF function normalised in all patients. AVWS was not observed in the TAH patients studied. Our findings demonstrate that patients with an implanted VAD experience a rapid onset of AVWS that is quickly and completely reversed after device explantation. In addition, TAH patients do not develop AVWS. These results suggest that shear stress associated with exposure of blood to VAD cannulas and tubes may contribute to the development of AVWS.
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Weber, Donna, Meletios Dimopoulos, Frank Sinicrope, and Raymond Alexanian. "VAD-Cyclosporine Therapy for VAD-Resistant Multiple Myeloma." Leukemia & Lymphoma 19, no. 1-2 (January 1995): 159–63. http://dx.doi.org/10.3109/10428199509059671.
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Kolmačka, Viktor. "Práva z vad při smíšeném darování." Časopis pro právní vědu a praxi 29, no. 3 (October 4, 2021): 447–82. http://dx.doi.org/10.5817/cpvp2021-3-1.
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Předmětem článku je problematika práv z vad v případě smíšeného darování. Tento druh prostředků nápravy předpokládá úplatnou povahu smlouvy, a proto bude nejprve osvětlen význam úplatnosti. Poté je pozornost věnována rozboru jak přistupovat k závazku, který má charakter smíšeného darování, neboť současná česká nauka toto téma neobjasňuje. Konečně tento článek usiluje o nabídnutí řešení, za jakých předpokladů odpovídá zcizitel za vady svého plnění a jakým způsobem mají být práva z vad realizována.
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Kettyle, Shawna M., Nikhil L. Chervu, Appajosula Sarada Rao, Salaam Sadi, David Majure, Jack A. Sava, and Laura S. Johnson. "Outcomes following Noncardiac Surgery in Patients with Ventricular Assist Devices: A Single-Center Experience." American Surgeon 83, no. 8 (August 2017): 842–46. http://dx.doi.org/10.1177/000313481708300833.
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The Prevalence of ventricular assist devices (VADs) is increasing as advanced cardiac therapies progress. These patients commonly require non-cardiac surgical procedures (NCS), although data are scant regarding the safety, timing, and operations that may safely be performed. We aim to describe our experience with VAD patients undergoing NCS. We retrospectively reviewed records on patients who underwent NCS after VAD implantation between 2013 and 2015 at a single Joint Commission–accredited VAD institution. Data collection included demographics, ischemic cardiomyopathy or nonischemic cardiomyopathy, operative details, and perioperative anticoagulation management and outcomes. Seventy-two NCS were performed by general surgeons, thoracic surgeons, plastic surgeons, urologists, vascular surgeons, ENTs, and other services. Procedures were similarly varied, including video-assisted thoracoscopy with decortications or lung biopsy, tracheostomies, percutaneous endoscopic gastrostomies, exploratory laparotomies, and wound debridements and/or closures. The ten deaths in the study group were judged not to be directly related to NCS. Eleven cases had postoperative bleeding and two cases had postoperative thrombosis, including one pump thrombosis. Based on our results, VAD is not an absolute contraindication to NCS, and a variety of NCS procedures can safely be performed. Further study should focus on quantifying and mitigating the risk that VADs bring to NCS.
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Roberts, Scott C., Hannah H. Nam, Rebecca N. Kumar, Teresa Zembower, Chao Qi, Michael Malczynski, Jonathan D. Rich, Amit A. Pawale, Rebecca S. Harap, and Valentina Stosor. "584. Ventricular assist device infections with Pseudomonas aeruginosa." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S356. http://dx.doi.org/10.1093/ofid/ofaa439.778.
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Abstract Background Infection is a leading cause of morbidity and mortality in ventricular assist device (VAD) recipients. Pseudomonas aeruginosa (PA) is the second most common organism implicated in VAD infections, occurring in 10–50% of infections. The epidemiology of VAD recipients with PA infection are poorly described. Methods We identified patients (pts) at Northwestern Memorial Hospital with a VAD-specific PA infection from January 1, 2012 to Dec 31, 2019. VADs included the Heartmate II, Heartmate 3, and Heartware HVAD devices. VAD-specific infections were defined according to the 2013 ISHLT Guidelines. Results Seventeen out of 91 (18.7%) VAD infections were due to PA. Infections of the driveline exit site (DLES) occurred most commonly (n=15, 88.2%), followed by pocket (n=2, 11.8%) and pump (n=2, 11.8%) infections. Median time to infection after VAD implantation was 295 days (IQR 154 – 440 days). Eight (47.1%) pt isolates were not fluoroquinolone (FQ) susceptible. Resistance to multiple antibiotic classes was observed in pts in whom serial cultures were obtained. Median antibiotic treatment was 107 days (IQR 55 – 183 days, maximum 775 days). Five (29.4%) pts received FQ monotherapy on initial diagnosis, 3 (60%) of whom required change to a different class for resistance. Surgical debridement and VAD exchange were performed in 5 (29.4%) and 3 (17.6%) pts respectively. Co-pathogens were identified in 9 (52.9%) pts, the most common being Staphylococcus aureus (n=2) and Enterococcus spp (n=2). A total of 5 (29.4%) pts went on to successful heart transplantation; one had recurrent PA infection at the prior DLES requiring prolonged antibiotics and removal of retained DL material. All cause 1-year mortality rate was 11.7% (n = 2), both of whom died from cerebrovascular accidents. Conclusion VAD-specific infections with PA occurred late after device implantation and required prolonged antibiotic courses. Antimicrobial resistance was high at diagnosis and worsened in pts on prolonged therapy. Morbidity and mortality in pts with PA VAD infections were high. The preponderance of DLES infections warrants further study and highlights the need for improvements in DLES care and infection prevention strategies. Disclosures All Authors: No reported disclosures
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Adachi, Iki, Vadim Kostousov, Lisa Hensch, Martin Chacon-Portillo, and Jun Teruya. "Management of Hemostasis for Pediatric Patients on Ventricular-Assist Devices." Seminars in Thrombosis and Hemostasis 44, no. 01 (November 17, 2017): 030–37. http://dx.doi.org/10.1055/s-0037-1607982.
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AbstractVentricular-assist devices (VADs) have seen increased utilization in the pediatric population. Formerly, this therapeutic modality was limited to only the pulsatile VAD, EXCOR (Berlin Heart GmbH). However, the continuous flow VAD devices, HeartMate II (Abbott Inc.) and HeartWare (Medtronic Inc.), are now increasingly used in this population. Postoperatively, VAD patients are acutely anticoagulated using unfractionated heparin, often beginning 24 to 48 hours after VAD placement. Once the patient is stabilized and ready to transition to a lower acuity or outpatient setting, low-molecular-weight heparin or warfarin therapy may be instituted. Also, because of the risk for thrombotic and thromboembolic complications, antiplatelet strategies are employed using medications such as aspirin, clopidogrel, or dipyridamole. Platelet-rich plasma or whole blood platelet aggregation studies, platelet function analyzer-100 (Siemens), VerifyNow (Accriva Diagnostics), or thromboelastography platelet mapping (Haemonetics) may be used to help monitor antiplatelet effects, though the interpretation of the strength of the antiplatelet effect remains difficult. Care must be taken to monitor the hematologic complications of VAD, including acquired von Willebrand syndrome, which increases the risk for bleeding, and intravascular hemolysis, which increases the risk of thrombosis. Appropriate device placement and anticoagulation management are imperative to help avoid neurological dysfunction and ischemic stroke, the most devastating potential complications of VAD therapy. As our experience grows, we continue to gain an increased understanding of the management of anticoagulation, need for antiplatelet medication, and appropriate monitoring for these critical patients.
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Ryu, Jiwook, Kyung Mi Lee, Hyug-Gi Kim, Seok Keun Choi, and Eui Jong Kim. "Diagnostic Performance of High-Resolution Vessel Wall Magnetic Resonance Imaging and Digital Subtraction Angiography in Intracranial Vertebral Artery Dissection." Diagnostics 12, no. 2 (February 8, 2022): 432. http://dx.doi.org/10.3390/diagnostics12020432.
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Purpose: Intracranial vertebral artery dissection (VAD) is being increasingly recognized as a leading cause of Wallenberg syndrome and subarachnoid hemorrhage. Conventional angiography is considered the standard diagnostic modality, but the diagnosis of VAD remains challenging. This study aimed to compare the diagnostic performance of high-resolution vessel wall imaging (HR-VWI) with digital subtraction angiography (DSA) for intracranial VAD. Materials and methods: Twenty-four patients with 27 VADs, who underwent both HR-VWI and DSA within 2 weeks, were consecutively enrolled in the study from March 2016 to September 2020. HR-VWI and DSA were performed to diagnose VAD and to categorize its angiographic features as either definite dissection or suspicious dissection. Features of HR-VWI were used to evaluate direct arterial wall imaging. The reference standard was set from the clinicoradiologic diagnosis. Two independent raters evaluated the angiographic features, dissection signs, and interrater agreement. Each subject was also dichotomized into two groups (suspicious or definite VAD) in each modality, and diagnosis from HR-VWI and DSA was compared with the final diagnosis by consensus. Results: HR-VWI had higher agreement (90.6% vs. 53.1%) with the final diagnosis and better interrater reliability (kappa value (κ) = 0.91; 95% confidence interval (CI) = 0.64–1.00) compared with DSA (κ = 0.58; 95% CI = 0.35–1.00). HR-VWI provided a more detailed identification of dissection signs (77.7% vs. 22.2%) and better reliability (κ = 0.88; 95% CI = 0.58–1.00 vs. κ = 0.75; 95% CI = 0.36–1.00), compared to DSA. HR-VWI was comparable to DSA for the depiction of angiographic features for VAD. Conclusions: HR-VWI may be useful to evaluate VAD, with better diagnostic confidence compared to DSA.
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Krause, Kaisa. "Vad innebär professionalism och vad förutsätter den av sjukskötaren?" Nordic Journal of Nursing Research 14, no. 4 (December 1994): 31–37. http://dx.doi.org/10.1177/010740839401400407.
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Zhou, Yunting, Junming Zhou, Yumin Zhang, Jun Tang, Bo Sun, Wei Xu, Xiaohang Wang, Yang Chen, and Zilin Sun. "Changes in Intestinal Microbiota Are Associated with Islet Function in a Mouse Model of Dietary Vitamin A Deficiency." Journal of Diabetes Research 2020 (January 22, 2020): 1–10. http://dx.doi.org/10.1155/2020/2354108.
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Aims. The underlying mechanisms involved in Vitamin A- (VA-) related changes in glucose metabolic disorders remain unclear. Recent evidence suggests that intestinal microbiota is closely linked to the metabolic syndrome. Here, we explored whether and how intestinal microbiota affects glucose homeostasis in VA-deficient diet-fed mice. Methods. Six-week-old male C57BL/6 mice were randomly placed on either a VA-sufficient (VAS) or VA-deficient (VAD) diet for 10 weeks. Subsequently, a subclass of the VAD diet-fed mice was switched to a VA-deficient rescued (VADR) diet for an additional 8 weeks. The glucose metabolic phenotypes of the mice were assessed using glucose tolerance tests and immunohistochemistry staining. Changes in intestinal microbiota were assessed using 16S gene sequencing. The intestinal morphology, intestinal permeability, and inflammatory response activation signaling pathway were assessed using histological staining, western blots, quantitative-PCR, and enzyme-linked immunosorbent assays. Results. VAD diet-fed mice displayed reduction of tissue VA levels, increased area under the curve (AUC) of glucose challenge, reduced glucose-stimulated insulin secretion, and loss of β cell mass. Redundancy analysis showed intestinal microbiota diversity was significantly associated with AUC of glucose challenge and β cell mass. VAD diet-driven changes in intestinal microbiota followed the inflammatory response with increased intestinal permeability and higher mRNA expression of intestinal inflammatory cytokines through nuclear factor-κB signaling pathway activation. Reintroduction of dietary VA to VAD diet-fed mice restored tissue VA levels, endocrine hormone profiles, and inflammatory response, which are similar to those observed following VAS-controlled changes in intestinal microbiota. Conclusions. We found intestinal microbiota effect islet function via controlling intestinal inflammatory phenotype in VAD diet-fed mice. Intestinal microbiota influences could be considered as an additional mechanism for the effect of endocrine function in a VAD diet-driven mouse model.
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Shibahara, Tomoya, Masahiro Yasaka, Yoshiyuki Wakugawa, Koichiro Maeda, Takeshi Uwatoko, Takahiro Kuwashiro, Gregory Y. H. Lip, and Yasushi Okada. "Improvement and Aggravation of Spontaneous Unruptured Vertebral Artery Dissection." Cerebrovascular Diseases Extra 7, no. 3 (October 17, 2017): 153–64. http://dx.doi.org/10.1159/000481442.
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Background: Intracranial vertebral artery dissection (VAD) is a well-recognized cause of stroke in young and middle-aged individuals, especially in Asian populations. However, a long-term natural course remains unclear. We investigated the long-term time course of VAD using imaging findings to examine the rate and predisposing factors for improvement. Methods: We registered 56 consecutive patients (40 males; mean age, 51.8 ± 10.7 years) with acute spontaneous VAD and retrospectively investigated neuroimaging and clinical course within 1 month and at 3 months ± 2 weeks, 6 months ± 2 weeks, and 12 months ± 2 weeks after onset to ascertain predisposing factors and time course for improvement. Results: The most common presenting symptoms were headache and/or posterior neck pain, seen in 41 patients (73%). Magnetic resonance imaging showed brainstem and/or cerebellum infarction in only 32 patients (57%). Of the 56 VADs, 16 (28%) presented with pearl and string sign, 5 (9%) with pearl sign, 15 (27%) with string sign, and 20 (36%) with occlusion sign. VAD occurred on the dominant side in 20 patients and on the nondominant side in the other 36 patients. The pearl and string sign was more frequently noted on the dominant side than on the nondominant side (50 vs. 17%, p = 0.008). On the other hand, occlusion occurred more often on the nondominant side than on the dominant side (47 vs. 15%, p = 0.016). Furthermore, the pearl and string sign was more frequently seen in the improvement group (41 vs. 15%, p = 0.028), whereas the occlusion sign was evident more frequently in the nonimprovement group (21 vs. 52%, p = 0.015). Follow-up neuroimaging evaluation was performed at 1 and 3 months in 91% each, and at 6 and 12 months in 82% each. VAD aggravation was identified within 1 month after onset in 14%, while VAD improvement was seen in 14, 38, 50, and 52% at each period, mainly within 6 months after onset. Older patients and current smoking were negatively associated with VAD improvement. Conclusions: VAD improvement primarily occurs within 6 months after onset, and VAD aggravation within 1 month. It seems that older patients and current smoking are negative predictors of VAD improvement as risk factors, and as image findings, the pearl and string sign is a positive predictor and occlusion a negative predictor.
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Mattsson, Margareta, and Niklas Rådström. "Vad du vill." World Literature Today 70, no. 3 (1996): 718. http://dx.doi.org/10.2307/40042242.
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Nyberg, Anita. "Vad är förvärvsarbete?" Tidskrift för genusvetenskap 8, no. 1 (June 23, 2022): 54–65. http://dx.doi.org/10.55870/tgv.v8i1.5473.
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Vad menas egentligen med förvärvsarbete? Hur har begreppet tilllämpats i statistiken över mäns och kvinnors arbete? Anita Nyberg visar här hur förvärvsstatistiken både speglar och skapar ideologin om vad som är arbete. Den osynliggör kvinnoarbetet.
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Andrén, Anders. "Vad var Vandilsvé?" Religionsvidenskabeligt Tidsskrift 74 (March 25, 2022): 513–24. http://dx.doi.org/10.7146/rt.v74i.132120.
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ABSTRACT: Vandilsvé is mentioned one single time in Helgakviða Hundingsbana II:35, and it is usually understood as a theophoric place-name. The first element has been read as the name of an otherwise unknown Vandal god, *Vandill, but this interpretation has fallen out of favour today. Another reading is based on the fact that sacral names ending in -vé (-vi) do not necessarily have names of deities as their first element. An example is Töravi, which derives from the old name for the island of Södertörn (Tör) and means “the sacred place of the inhabitants of Tör”. As a parallel to Töravi, it is possible that Vandilsvé refers to Vendill, the old name for the district of Vendsyssel, and means “the sacred place of the inhabitants of Vendel”. Supported by archaeology, the discussion focuses on four different sites in Vendsyssel, which might more or less plausibly represent Vandilsvé; these are Lindholm Høje, Stentinget, Liver, and Ejstrup. In conclusion, it is discussed what impact such an interpretation may have for our understanding of the three eddic poems about Helgi Hundingsbani and Helgi Hjörvarðsson.
SAMMANDRAG: Vandilsvé omtalas en enda gång i Helge Hundingsbane II:35, och brukar uppfattas som ett teofort namn för en plats. Förleden har tolkats som namnet på en för övrigt okänd vandalsk gud *Vandill, men få tror idag på denna tolkning. En annan tolkning kan utgå från att vissa sakrala namn på -vé (-vi) inte har gudanamn som förled utan andra företeelser. Ett exempel är Töravi, som kommer av det gamla namnet för ön Södertörn (Tör), och som betyder ”Törbornas helgedom”. Som en parallell till Töravi skulle Vandilsvé kunna syfta på Vendill, det gamla bygdenamnet för Vendsyssel, och betyda ”Vendelbornas helgedom”. Med hjälp av arkeologi diskuteras fyra olika platser i Vendsyssel, vilka med större eller mindre sannolikhet skulle kunna representera Vandilsvé, nämligen Lindholm Høje, Stentinget, Liver och Ejstrup. Avslutningsvis diskuteras vad en sådan tolkning kan ha för konsekvenser för synen på de tre Edda-dikterna om Helge Hundingsbane och Helge Hjörvardsson.
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