Heart failure (HF) is defined as a clinical syndrome due any structural or functional cardiac disorder that impairs the ability of the heart to pump blood to meet organ needs. After a diagnosis of HF, survival estimates are 50% and 10% at 5 and 10 years, respectively. HF is characterized by periodic exacerbations and is the single most frequent disease that cause hospitalization. Although heart transplantation (HTx) is still regarded as the gold standard in the surgical treatment of terminal HF affecting patient under 65 years old, this solution has been decreasing progressively in recent years. A ventricular assist device (VAD) is a mechanical pump that's used to support heart function and blood flow in people who have weakened hearts. VAD takes blood from a lower chamber of the heart and helps pump it to the body and vital organs, just as a healthy heart would. An implantable VAD has its pump located inside of the body and its power source located outside of the body. A cable connects the pump to the power source through a small hole in the abdomen. Implantable VADs are used mainly for people who are waiting for HTx or as a long-term solution for people who can't have HTx. SensorART aims at sensorizing VADs, in order to turn VADs from mechanical devices into intelligent systems allowing patients suffering from heart failure to conduct normal lives and help healthcare professionals to monitor patient status remotely and in real-time. In practice this means that in patients with implanted sensorised artificial heart, the device is linked wirelessly to an external control unit. The artificial heart is powered wirelessly by an innovative system for energy transfer via the skin. Thanks to different assembled sensors, as well as to special algorithms, the control unit can monitor the patient’s physiological conditions and optimise support from the pump. In this way, the empowered patient can lead a normal life. Moreover, via wireless Internet communication, the control unit allows doctors to monitor the patient’s status in real-time and remotely, and to take immediate action when required. There are two distinct periods in the VAD patient management: the immediate postoperative in-hospital phase and the later phase after discharge. The immediate post- operative phase is characterized by adverse events like post-surgical bleeding, tamponade, multiple-organ failure and possibly death. It is intuitive that inflammatory parameters can play an important indicative role in this first phase. Although not negligible, altered inflammatory signals during chronic phase of VAD support might affect biological systems, such as von Willebrand factor system and coagulation, that impact on long-term outcome. Indeed, in the second phase of care during follow up, major adverse events in patients with mechanical circulatory support are VAD malfunction, thrombosis, bleeding and infection (driveline or device infection). In this work we specifically analysed biomarkers that can be expected to be related with VAD related adverse outcomes: 1) the role of inflammatory biomarkers and new biomarkers associated to cardiac injury and catabolic state, particularly, in the early postoperative phase after VAD implantation, and 2) the role of inflammatory biomarkers in the chronic phase.

(2016). Dal Progetto Europeo SensorArt all’attività di ricerca clinica: focus sui pazienti in assistenza ventricolare meccanica. (Tesi di dottorato, Università degli Studi di Milano-Bicocca, 2016).

Dal Progetto Europeo SensorArt all’attività di ricerca clinica: focus sui pazienti in assistenza ventricolare meccanica

VERDE, ALESSANDRO
2016

Abstract

Heart failure (HF) is defined as a clinical syndrome due any structural or functional cardiac disorder that impairs the ability of the heart to pump blood to meet organ needs. After a diagnosis of HF, survival estimates are 50% and 10% at 5 and 10 years, respectively. HF is characterized by periodic exacerbations and is the single most frequent disease that cause hospitalization. Although heart transplantation (HTx) is still regarded as the gold standard in the surgical treatment of terminal HF affecting patient under 65 years old, this solution has been decreasing progressively in recent years. A ventricular assist device (VAD) is a mechanical pump that's used to support heart function and blood flow in people who have weakened hearts. VAD takes blood from a lower chamber of the heart and helps pump it to the body and vital organs, just as a healthy heart would. An implantable VAD has its pump located inside of the body and its power source located outside of the body. A cable connects the pump to the power source through a small hole in the abdomen. Implantable VADs are used mainly for people who are waiting for HTx or as a long-term solution for people who can't have HTx. SensorART aims at sensorizing VADs, in order to turn VADs from mechanical devices into intelligent systems allowing patients suffering from heart failure to conduct normal lives and help healthcare professionals to monitor patient status remotely and in real-time. In practice this means that in patients with implanted sensorised artificial heart, the device is linked wirelessly to an external control unit. The artificial heart is powered wirelessly by an innovative system for energy transfer via the skin. Thanks to different assembled sensors, as well as to special algorithms, the control unit can monitor the patient’s physiological conditions and optimise support from the pump. In this way, the empowered patient can lead a normal life. Moreover, via wireless Internet communication, the control unit allows doctors to monitor the patient’s status in real-time and remotely, and to take immediate action when required. There are two distinct periods in the VAD patient management: the immediate postoperative in-hospital phase and the later phase after discharge. The immediate post- operative phase is characterized by adverse events like post-surgical bleeding, tamponade, multiple-organ failure and possibly death. It is intuitive that inflammatory parameters can play an important indicative role in this first phase. Although not negligible, altered inflammatory signals during chronic phase of VAD support might affect biological systems, such as von Willebrand factor system and coagulation, that impact on long-term outcome. Indeed, in the second phase of care during follow up, major adverse events in patients with mechanical circulatory support are VAD malfunction, thrombosis, bleeding and infection (driveline or device infection). In this work we specifically analysed biomarkers that can be expected to be related with VAD related adverse outcomes: 1) the role of inflammatory biomarkers and new biomarkers associated to cardiac injury and catabolic state, particularly, in the early postoperative phase after VAD implantation, and 2) the role of inflammatory biomarkers in the chronic phase.
GIANNATTASIO, CRISTINA
heart failure; VAD; SensorART; telemedicine; biomarkers; microRNA
MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE
Italian
IPERTENSIONE E PREVENZIONE DEL RISCHIO CARDIOVASCOLARE - 50R
28
2014/2015
(2016). Dal Progetto Europeo SensorArt all’attività di ricerca clinica: focus sui pazienti in assistenza ventricolare meccanica. (Tesi di dottorato, Università degli Studi di Milano-Bicocca, 2016).
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/132656
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