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Effect of continuous blood flow on cerebrovascular perfusion and hemocoagulation in patients with implantable left ventricular assist device
Koňařík, Miroslav ; Szárszoi, Ondrej (advisor) ; Ošťádal, Petr (referee) ; Brát, Radim (referee)
Implantation of left ventricular assist devices (LVADs) is an integral treatment modality in patients with heart failure. In most cases, it refers to a machine which generates continuous blood flow with reduced pulse pressures. The effect of reduced pulsatility on organ function, such as homeostatic regulatory mechanisms is still unknown. The goal of our study was to understand whether continuous blood flow generated by mechanical support devices affects cerebrovascular regulatory mechanisms (study A), and whether or not hemocoagulation is affected in regard to complications relating to hemocompatibility (study B). Study A utilized finger plethysmography and TCD ultrasonography to detect possible changes in static cerebral auto-regulation when compared to a range of rotations per minute (rpm) of the LVAD, which served as a model for either accentuation or reduction in residual arterial pulsatility. Study B divided patients with implanted LVADs based on the incidence of selected thrombophilic mutations. Both groups of patients were placed on individualized anticoagulation protocols. The results were focused on the incidence of thromboembolic and hemorrhagic complications, and eventual morbidity/mortality of the patient. Our findings did not confirm disruption to static cerebral auto-regulation,...
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Allooimmunosensitization in left ventricular assist device recipients and impact on post-transplantation outcome
Urban, Marián ; Netuka, Ivan (advisor) ; Ošťádal, Petr (referee) ; Mrázek, František (referee)
Background: In recent years mechanical circulatory assist devices became an established option in bridging patients with refractory heart failure to heart transplantation. One of the alleged limitations of mechanical devices is a high degree of antibody production with possible deleterious effect on subsequent heart transplantation outcome. Aim: The main goal of this study is to assess the role of antibodies on the outcome of surgical treatment of patients with end- stage heart failure. Method: Firstly, we present a literature review on the current state of knowledge of possible immunologic mechanisms involved in antibody production in left ventricular assist device (LVAD) recipients, new methods of antibody detection, desensitization strategies and overview of published evidence assessing the impact of sensitization on post-transplantation outcome. In the experimental part of our study we prospectively evaluated the presence of anti-Angiotensin II Type 1 Receptor (AT1R) antibodies in 83 Heart Mate II (HMII) recipients who were implanted at our institution between 2008 and 2012 and survived the first 60 days. On-device survival and device malfunction, major infection, major bleeding and neurologic dysfunction were compared between antibody positive and antibody negative recipients. Out of a total...
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Life after a heart transplant
Kováčová, Anna ; Kordulová, Pavla (advisor) ; Dynáková, Šárka (referee)
Patients with terminal heart failure that cannot be treated with conventional therapies are indicated for heart transplantation. In acute deterioration, patients can be brought to transplant using a mechanical cardiac support that is able to partially or completely take over the role of the heart and allow the restoration of sufficient cardiac output (Fila et al., 2014). The period before and after transplantation represents a very challenging period for patients, when they feel not only physical, but especially mental and social needs, which change during their phases of life and at the same time affect their entire subsequent experience. The main goal of this diploma thesis was to monitor how the previous implantation of long-term mechanical cardiac support and the subsequent heart transplantation affect the needs and feelings of patients. Respondents were selected from patients who had been implanted with mechanical cardiac support prior to heart transplantation. The diploma thesis contained another five sub- objectives, which dealt with mapping the needs of patients before and after implantation of long- term mechanical cardiac support and after heart transplantation, as well as during compliance with regimen measures, information retrieval and education. For qualitative research, the method of...
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Allooimmunosensitization in left ventricular assist device recipients and impact on post-transplantation outcome
Urban, Marián ; Netuka, Ivan (advisor) ; Ošťádal, Petr (referee) ; Mrázek, František (referee)
Background: In recent years mechanical circulatory assist devices became an established option in bridging patients with refractory heart failure to heart transplantation. One of the alleged limitations of mechanical devices is a high degree of antibody production with possible deleterious effect on subsequent heart transplantation outcome. Aim: The main goal of this study is to assess the role of antibodies on the outcome of surgical treatment of patients with end- stage heart failure. Method: Firstly, we present a literature review on the current state of knowledge of possible immunologic mechanisms involved in antibody production in left ventricular assist device (LVAD) recipients, new methods of antibody detection, desensitization strategies and overview of published evidence assessing the impact of sensitization on post-transplantation outcome. In the experimental part of our study we prospectively evaluated the presence of anti-Angiotensin II Type 1 Receptor (AT1R) antibodies in 83 Heart Mate II (HMII) recipients who were implanted at our institution between 2008 and 2012 and survived the first 60 days. On-device survival and device malfunction, major infection, major bleeding and neurologic dysfunction were compared between antibody positive and antibody negative recipients. Out of a total...
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Problems of patients with left ventricular asisst device and access nursing sisters.
CHAMROVÁ, Anna
In my thesis we devote to problems of patients with the implanted system HeartMate II, which is now approved as a support for an indication to bridging the time to heart transplantation and for a destination therapy for patients with a refractory heart failure. We also devote to the access of nurses to these patients. The theoretical part of the thesis is generally devoted to mechanical cardiac supports and indications to their introduction. Next part describes HeartMate II, specifics of the nursing care for a patient who is after implantation mechanical cardiac support HeartMate II and limitations, which follow for a patient at home. The target of the work is to: 1. Find out, what the priorities of needs of the patient with a mechanical cardiac support are in a nursing care. 2. Find out, how the patient with a mechanical cardiac support perceives himself and his future. 3. Find out possibilities of nursing interventions to a saturation of needs by priorities of patients with mechanical cardiac supports. For the qualitative part of the empirical research the method of questioning with technique a semi-structured interview with opened questions was chosen. The research group consists of four patients after the implantation of left-hand mechanical cardiac supports HeartMate II. In this part we were finding out answers to four research questions. 1. Which damaged needs are predominant by patients with mechanical cardiac supports? 2. Do patients with mechanical cardiac supports have enough information about possible complications related to the life after the implantation of a mechanical support? 3. How does the patient with a mechanical cardiac support perceive his future? 4. How does the patient with the mechanical cardiac support HeartMate II perceive himself? Then results of research were analyzed and written into schemes. In the quantitative part of the research four hypotheses were determined. 1. Interventions of nurses during a nursing care which is oriented to monitoring of vital functions are predominant over the orientation of needs that are changed by the life with a mechanical cardiac support. 2. Nurses are available to answer to patients with mechanical cardiac supports questions which are related to a service of the device HeartMate II. 3. Nurses are well informed about possible complications after the implantation of the left-hand mechanical support. 4. Nursing interventions of nurses are predominant over interventions of the other members of the team during the care of patient after the implantation of the left-hand mechanical cardiac support. The research group of the research consists of nurses, who are working at the department with beds, the intensive care unit of clinic of a cardiovascular surgery and at the resuscitation department of an anaesthesiology and resuscitation in IKEM. 95 respondents were addressed. The returnability of questionnaires was 69% from the beginning number. On the basis of the result of the research we think that targets were fulfilled. Patients have enough information about complications related with the life with the mechanical cardiac support HeartMate II. Patients consider a satisfaction of psychical needs, especially the feeling of a safety and a security, as a priority, although they are highly specific problems. In this view a psychotherapeutic access and a therapeutic communication of a nurse with a patient are important. We are going to hand results of the research over to the management of IKEM. A thematic schedule of a tutorial was created. This tutorial engaged in psychic needs of a patient, a psychotherapeutic access of nurses and a therapeutic communication with a patient.
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