Background: Peripartum cardiomyopathy (PPCM) is a rare, life-threatening form of heart disease, frequently associated with gene alterations and, in some cases, presenting with advanced heart failure. Little is known about ventricular assist device (VAD) implantation in severe PPCM cases. We describe long-term follow-up of PPCM patients who were resistant to medical therapy and received mechanical circulatory support or heart transplant. Methods and results: A total of 13 patients were included with mean follow-up of eight years. Mean age of PPCM onset was 33.7 ± 7.7 years. All patients were initially treated with angiotensin-converting enzyme inhibitors and beta-blockers, and four received bromocriptine. Overall, five patients received VADs (three biventricular, two isolated left ventricular) at median 27 days (range: 3 to 150) following childbirth. Two patients developed drive line infection. Due to the short support time, none of those patients had a stroke or VAD thrombosis. In total, five patients underwent heart transplantation, of which four previously had implanted VADs. Median time to transplantation from PPCM onset was 140 days (range: 43 to 776), and time to transplantation from VAD implantation were 7, 40, 132, and 735 days, respectively. All patients survived until most recent follow up, with the exception of one patient who died following unrelated abdominal surgery two years after PPCM recovery. Conclusions: In patients with severe, life-threatening PPCM refractory to medical management, mechanical circulatory support with or without heart transplantation is a safe therapeutic option.

Background: To assess whether the standardized recommendation of patients with heart failure (HF), left-ventricular assist device (LVAD) and heart transplantation (HTx) to visit their dentist leads to improved oral conditions after 12 months. Methods: Patients from the Department of Cardiothoracic Surgery, Leipzig Heart Centre, Germany were examined at baseline and after 12 months. A dental (decayed-, missing-, and filled-teeth index (DMF-T)) and periodontal examination (periodontal probing depth, clinical attachment loss) was performed. At baseline, patients received a standardized recommendation to visit their dentist. At follow-up, a standardized questionnaire regarding the dental consultation was applied. Results: Eighty-eight participants (HTx: 31, LVAD: 43, HF: 14) were included. The majority of patients (79.5%) followed the recommendation to visit their dentist. Within the total cohort, periodontal treatment need was significantly reduced from 91% (baseline) to 75% (follow-up; p < 0.01). Only 10% of total cohort stated that they received periodontal treatment. The outcome in periodontal and dental treatment need at follow-up appointment revealed no statistically significant associations to the questionnaire regarding dentist consultation (p > 0.05). Conclusions: The simple recommendation to visit the dentist appears not enough to obtain sufficient dental and periodontal conditions in patients with severe heart diseases. Thereby, a lack in periodontal treatment of patients with HF, HTx and LVAD was identified, making interdisciplinary dental special care programs recommendable.

The number of patients that are waiting for heart transplants far exceed the number of available donor hearts. Left Ventricular Assist Devices are mechanical alternatives that can help and are helping several patients. They work by taking blood from the left ventricle and ejecting that blood into the aorta. In the University of Louisville they are developing a similar device that will take the blood from the aorta instead of the ventricle. This new device is called an Artificial Vasculature Device. In this thesis the arterial system and AVD are modeled and a simple control algorithm for the AVD proposed. The arteries are modeled as a tube with linear resistance and inertia followed by a chamber with linear compliance and last a tube with linear resistance. The model is identical to the 4-element Windkessel model. The values for the resistances, inertia and compliance are identified using pressure and flow measurements from the ventricle and aortic root from a healthy patient. In addition to the Windkessel model the aortic valve is also modeled. The valve is modeled as a drum that closes the aorta and the parameters identified like before. The measurements are also used to model the left ventricle by assuming it has a constant compliance profile. The AVD is modeled using common modeling structures for servo motors and simple structures for tubes and pistons. The values for the AVD could not be measured and identified so they are fetched from preliminary motor and part specifications. The control algorithm for the AVD uses a wanted load to create a reference aortic flow. This wanted aortic flow is then achieved by using a PI controller. With these models and controller the interaction between the arterial system and AVD is investigated. With this preliminary understanding of the interaction further research can be made in the future to improve the understanding and improve the AVD itself.

<p>The number of patients that are waiting for heart transplants far exceed the number of available donor hearts. Left Ventricular Assist Devices are mechanical alternatives that can help and are helping several patients. They work by taking blood from the left ventricle and ejecting that blood into the aorta. In the University of Louisville they are developing a similar device that will take the blood from the aorta instead of the ventricle. This new device is called an Artificial Vasculature Device. In this thesis the arterial system and AVD are modeled and a simple control algorithm for the AVD proposed. </p><p>The arteries are modeled as a tube with linear resistance and inertia followed by a chamber with linear compliance and last a tube with linear resistance. The model is identical to the 4-element Windkessel model. The values for the resistances, inertia and compliance are identified using pressure and flow measurements from the ventricle and aortic root from a healthy patient. In addition to the Windkessel model the aortic valve is also modeled. The valve is modeled as a drum that closes the aorta and the parameters identified like before. The measurements are also used to model the left ventricle by assuming it has a constant compliance profile. </p><p>The AVD is modeled using common modeling structures for servo motors and simple structures for tubes and pistons. The values for the AVD could not be measured and identified so they are fetched from preliminary motor and part specifications. </p><p>The control algorithm for the AVD uses a wanted load to create a reference aortic flow. This wanted aortic flow is then achieved by using a PI controller. With these models and controller the interaction between the arterial system and AVD is investigated. </p><p>With this preliminary understanding of the interaction further research can be made in the future to improve the understanding and improve the AVD itself.</p>

Objectifs: Malgré beaucoup de progrès dans la gestion médico-électrique, certains problèmes demeurent et plusieurs patients souffrant d'insuffisance cardiaque sont encore dans l'impasse. Ainsi, les dispositifs d'assistance ventriculaire gauche (LVAD) ont été développés pour réduire les conséquences de l'insuffisance cardiaque et améliorer la qualité de vie. Malgré les avantages évidents, plusieurs complications : thrombo-embolie, infection dû au câble d'alimentation externe, dépendance aux batteries demeurent. L'ICOMS est un nouveau concept de LVAD mélangeant une pompe entièrement intraventriculaire, synchronisé avec le cœur et relié à une batterie interne. Méthodes et résultats : L'intervalle de fonctionnement prévu est un débit de 0.8 to 6.7 10-5 m3/s à une vitesse de rotation de 733 to 942 rad/s, avec des pressions physiologiques. Le point de fonctionnement choisi pour la conception est un débit de 3.3 10-5 m3/s et 10.6 103 Pa . Dans cette étude, Une simulation numérique est réalisée avec des profils de lames différents pour chaque région de fluide étudié. Les performances telles que l'efficacité, la contrainte de cisaillement sont analysée pour vérifier l'efficacité pour les patients atteints d'insuffisance cardiaque. Afin d'obtenir le meilleur résultat avec le logiciel ANSYS, le modèle k-ε turbulent a été appliquée pour obtenir des caractéristiques d'écoulement entre l'entrée et à la sortie de l'évacuateur du redresseur de la pompe. Les résultats numériques montrent une performance acceptable pour les adultes pour délivrer des pressions physiologiques avec une efficacité hydraulique de 10 à 37% ainsi qu'un niveau acceptable de stress de cisaillement maximale le long de la surface de la partie mobile de la pompe. La deuxième partie de l'étude est une étude expérimentale où un prototype a été testé sur banc d'essai. Les résultats ont montré que la pompe pourrait fonctionner et améliorer le débit cardiaque de 1.7 à 6.7 10-5 m3/s. Les résultats in vitro convergent vers les résultats numériques. Pour les tests in vivo, 6 moutons ont été opérés pour l'implantation du LVAD. L'ICOMS a été implanté dans l'apex du ventricule gauche. Plusieurs paramètres hémodynamiques et échocardiographiques ont été stockés dans des conditions normales ou pathologiques. Conclusion: Nous avons montré que l'ICOMS pourrait présenter un effet potentiel pour réduire les conséquences de l'insuffisance cardiaque. De nouvelles expérimentations sont nécessaires pour confirmer notre résultat et optimiser ce nouveau LVAD / Objectives: Despite much progress in medical-electrical management, some problems remain and several heart failure patients are still in a no option solution. In this way, artificial hearts as Left Ventricular Assist Device (LVAD) have been developed. Despite evident benefits, several complications as thromboembolism, driveline infection, batteries dependency remain. ICOMS is a new LVAD concept mixing a fully intraventricular pump, heat rate-synchronized and connected with intracorporeal batteries. Methods and Results : It is expected to deliver 0.8 to 6.7 10-5 m3/s at rotational speeds of 733 to 942 rad/s over physiologic pressures and has a selected design point of 3.3 10-5 m3/s and 10.6 103 Pa . In this study, the axial blood pump with motor connected to impeller has been selected to numerical simulation. This selection is based on axial flow pump with different blade profile for each fluid region and studied on its performance such as efficiency, wall shear stress and considering effective operation for cardiac failure patients. In order to achieve the best result with the ANSYS software, k-ε turbulent model has been applied to obtain the flow characteristics from inducer inlet to straightener outlet of the pump. Numerical results show acceptable performance to deliver physiologic pressures with hydraulic efficiency of 10 to 37 % as well as acceptable maximum shear stress level along the blade tip surface of the impeller. The second part of the study is an experimental investigation where a prototype device was tested in a test bench circulation loop have shown that the pump could operate and improve the cardiac output of 1.7 to 6.7 10-5 m3/s. In vitro results converge to numerical results. For test vivo 6 sheep were operated for the LVAD implantation with the support of cardiopulmonary by-pass. The ICOMS was implanted into the LV apex. Several hemodynamic and echocardiographic parameters were stored as well as in normal or pathological conditions and analyzed. Conclusion: We showed that the ICOMS could present a potential effect in the LV support reducing the heart failure criteria. As evidence, further experimentations are necessary to confirm our result and to optimize this new LVAD

Patienten mit Herzinsuffizienz im Endstadium erhalten zunehmend linksventrikuläre Unterstützungssysteme (LVAD) als Dauertherapiemittel oder zur Überbrückung bis zu einer möglichen Herztransplantation. Diese Patientenklientel ist grundsätzlich durch die Driveline, als potenzielle Eintrittsstelle für Mikroorganismen, einem Infektionsrisiko ausgesetzt. Die Mundhöhle beinhaltet diverse Bakterien, die sich auch systemisch verbreiten können und so eine mögliche Quelle für Driveline-Infektionen darstellen. Es ist jedoch unklar, ob bei LVAD-Patienten Erkrankungen der Mundhöhle durch Bakteriämien zu systemischen Komplikationen und Driveline-Infektionen führen können. Aktuell fehlt es an Studien zum Mundgesundheitszustand bei diesen Patienten und über einen möglichen Zusammenhang von oralen Erkrankungen und Driveline-Infektionen. Ziel dieser Studie war daher die Beurteilung des Mundgesundheitsverhaltens, des Mundgesundheitszustands sowie der mundgesundheitsbezogenen Lebensqualität von LVAD-Patienten. Bei den in dieser Studie untersuchten LVAD-Patienten traten vermehrt schwere Parodontitiden auf. Da Parodontitis das Risiko und das Ausmaß einer systemischen Bakteriämie erhöht und möglicherweise zu kardiovaskulären Komplikationen führen könnte, kann dieser Zustand als potenziell problematisch betrachtet werden. Die aktuelle Studie konnte jedoch keinen Zusammenhang zwischen Driveline-Infektionen und dem vorliegenden zahnärztlichen Behandlungsbedarf bestätigen, sodass der Einfluss der Mundgesundheit auf systemische, krankheits- und gerätebezogene Parameter unklar bleibt. Insgesamt scheint die Erarbeitung eines interdisziplinären zahnärztlichen Versorgungskonzeptes nötig, um die unzureichende Mundgesundheitssituation von LVAD-Patienten zu verbessern.:1 Einführung 1.1 Herzinsuffizienz 1.1.1 Definition und Klassifikation 1.1.2 Ätiologie und Epidemiologie 1.1.3 Therapie 1.2 Ventrikuläre Unterstützungssysteme 1.2.1 Einteilung, Funktionsprinzipien und Aufbau 1.2.2 Indikation und Therapiekonzepte 1.2.3 Komplikationen und Überlebensraten 1.3 Mundgesundheit bei Herzinsuffizienzpatienten 1.3.1 Mundgesundheit 1.3.2 Karies 1.3.3 Parodontitis 1.3.4 Bedeutung der Mundgesundheit bei Herzinsuffizienzpatienten und zahnärztliche Therapiekonzepte 1.4 Zielsetzung und Fragestellung 2 Publikationsmanuskript 3 Zusammenfassung der Arbeit 4 Ausblick 5 Literaturverzeichnis 6 Wissenschaftliche Präsentationen 7 Darstellung des eigenen Beitrages 8 Erklärung über die eigenständige Abfassung der Arbeit 9 Danksagung

Background: The use of percutaneous left ventricular assist devices in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) is evolving. The aim of the study was to assess the long-term outcome of patients with AMICS depending on early initiation of Impella CP® support prior to a percutaneous coronary intervention (PCI). Methods: We retrospectively reviewed all patients who underwent PCI and Impella CP® support between 2014 and 2016 for AMICS at our institution. We compared survival to discharge between those with support initiation before (pre-PCI) and after (post-PCI) PCI. Results: A total of 73 consecutive patients (69±12 years old, 27.4% female) were supported with Impella CP® and underwent PCI for AMICS (34 pre-PCI vs. 39 post-PCI). All patients were admitted with cardiogenic shock, and 58.9% sustained cardiac arrest. Survival at discharge was 35.6%. Compared with the post-PCI group, patients in the pre-PCI group had more lesions treated (p=0.03), a higher device weaning rate (p=0.005) and higher survival to discharge as well as to 30 and 90 days after device implantation, respectively (50.0% vs. 23.1%, 48.5% vs. 23.1%, 46.9 vs. 20.5%, p < 0.05). Kaplan–Meier analysis showed a higher survival at one year (31.3% vs. 17.6%, log-rank p-value=0.03) in the pre-PCI group. Impella support initiation before PCI was an independent predictor of survival up to 180 days after device implantation. Conclusions: In this small, single-centre, non-randomized study Impella CP® initiation prior to PCI was associated with higher survival rates at discharge and up to one year in AMICS patients presenting with high risk for in-hospital mortality.

Abstract Background: Implantable cardioverter-defibrillator (ICD) surgery in patients with implanted left ventricular assist devices (LVAD) is associated with an increased risk of bleeding complications because of the need to ensure that these patients are adequately anticoagulated. Our study aimed to evaluate the safety of our new strategy of uninterrupted oral anticoagulation compared to heparin-bridging during the surgical interval. Methods: Between January 2009 and January 2020, 116 patients with LVAD underwent ICD surgery. Since January 2015, 60 patients were operated under continued sufficient oral anticoagulation with a vitamin k antagonist (VKA group). Fifty-six patients underwent a heparin-bridging regimen (heparin group). Demographics, perioperative data, complications, and mortality were analyzed. Results: Bleeding complications attributable to the surgical intervention occurred more often (19.6% vs. 10.0%, p = 0.142) and at a higher rate of re-exploratory surgery (14.3% vs. 5.0%, p = 0.088) in the heparin group without reaching statistical significance. Moreover, the heparin group patients' postoperative total length of stay was 10 days longer (17.8 ± 23.8 days vs. 8.3 ± 9.5 days, p = 0.007). There were no procedure-related deaths, no thromboembolic events, and no LVAD-related thrombosis. Conclusion: Our strategy of uninterrupted oral anticoagulation is safe and results in a reduction by more than half the number of days in hospital without an increase in adverse events.

The thesis discusses the education of patients with left ventricular support HeartMate II. Theoretical part is focused on education and its ethical and legal aspects, on the description of the educational process. Furthermore it focuses on heart supports, especially on left ventricular assist device HeartMate II. To provide a comprehensive overview, I have included also information about the anatomy and physiology of the cardiovascular system and the section on heart failure. I described the specifics of nursing care for patients with implanted HeartMate II system and the educational topics that should be part of the education of these patients. The empirical part was prepared as a quantitative research, where research sample was 47 respondents. Respondents consisted of nurses who educate patients after implantation of the HeartMate II at the cardiovascular surgical intensive care unit. To create the feedback I complemented a quantitative research with structured interviews with patients after implantation of the HeartMate II. The aim of the research was to determine the status and range of education of patients with left ventricular assist device HeartMate II. This thesis further maps the topics on which is placed the emphasis in education and vice versa topics that would need to focus more on....

Plasma levels of B-type natriuretic peptide (BNP) are a strong and independent predictor of prognosis in patients with advanced heart failure (CHF). However, the importance of this biomarker has been documented only in CHF of common causes such as dilated or ischemic cardiomyopathy. We hypothesized that BNP can serve as a strong predictor of end-stage CHF in group of patients with advanced CHF due to congenital heart disease (CHD) with the right ventricle in systemic position (SRV). The second hypothesis was that BNP monitoring in patients with implanted left ventricular assist device (LVAD) Heart Mate II could detect serious complications which negatively affect prognosis. We performed a retrospective analysis in 28 consecutive patients with severe systolic dysfunction of the SRV (ejection fraction 23 ± 6%) evaluated as heart transplant (HTx) candidates between May 2007 and October 2014. During a median follow-up of 29 months (interquartile range, 9-50), 14 pts reached primary endpoints of the study (death, urgent HTx, and LVAD implantation). We have considered these events equivalent to end-stage CHF. Using ROC analysis, we identified the first measured value of BNP as the strongest predictor of prognosis with the area under the curve (AUC) of 1.00, followed by the New York Heart Association...