Showing 5 ideas for tag "ventricular"

Goal 2: Reduce Human Disease

In pulmonary arterial hypertension (PAH), how can right ventricular function be improved in the setting of increased afterload

Pulmonary arterial hypertension (PAH) is a complex, progressive condition characterized by high blood pressure in the lungs and restriction of flow through the pulmonary arterial system. Significant improvements have been made in medical management with through approved pulmonary vasodilator therapies. However, long-term right ventricular afterload reductions have still not yet been achieved. The process by which the... more »

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Compelling Question (CQ)

Details on the impact of addressing this CQ or CC

Understanding of many components of the PAH disease state have evolved significantly in the past thirty years. When initially described by an NIH registry, in a time where pulmonary transplantation was the only treatment for PAH, the average life expectancy of PAH patients was estimated to be 2.8 years. Since then, 12 PAH-targeted therapies have been approved by the FDA; these therapies primarily act by dilating the pulmonary arteries in order to allow blood to flow easier through the pulmonary vascular system. Despite these advances and complex therapies, long-term afterload reduction is not achievable in most PAH patients. Patients continue to die from right ventricular failure, highlighting the important relationship of the pulmonary arterial system and right ventricle. Little is known about how and why the RV progresses from hypertrophy to full RV failure, the diagnostic signs indicating early RV failure, and how best to intervene to support the failing ventricle. Knowledge in this area is critical, however, as the RV is able to recover in many patients with severe PAH after lung transplantation. The relationship between the lung vasculature and cardiac function, and specifically a characterization of RV failure, was included as a research opportunity in the Strategic Plan for Lung Vascular Research in an NHLBI-ORDR Workshop Report (Erzurum S, et al. 2010).

Feasibility and challenges of addressing this CQ or CC

The primary challenge of addressing this CQ on how right ventricular function can be improved in the setting of increased afterload is the comprehensive analysis and support that will need to be provided, spanning from basic to clinical science. To begin, strong support of biologic characterization of the right ventricle needs to be provided. The RV is distinctly different from the more comprehensively studied left ventricle (LV), and subsequently responds differently to changes in pressure, neurotransmitters, hormones, and pharmaceutical therapies to name only a few. However, when identified, these RV biologic distinctions can be further explored to develop a better understanding of RV failure and potential points of intervention.

Name of idea submitter and other team members who worked on this idea Katherine Kroner, Michael Patrick Gray, PHA

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72 up votes
7 down votes
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Goal 2: Reduce Human Disease

Optimal Use of mechanical circulatory support devices to Minimize Pump Thrombosis & AEs

There is a need for the development of a collaborative observational study that leverages off of existing registries, such as INTERMACS and STS, that will follow mechanical circulatory support devices (mechanical circulatory support device) patients prospectively and collect process-of-care data to identify 1) optimal approaches for the management of patients and 2) pumps to minimize the occurrence of adverse hemodynamic... more »

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Details on the impact of addressing this CQ or CC

Completion of the proposed observational study would optimize mechanical circulatory support device/left ventricular assist device use and minimize serious adverse events such as pump thrombosis.

Feasibility and challenges of addressing this CQ or CC

Use of mechanical circulatory support is expanding to less sick populations, so optimal and safe use of these devices is critical.
Mechanical circulatory support devices (mechanical circulatory support device) have become important therapeutic options for patients with advanced heart failure. Considerable efforts are underway to develop newer generations of devices that are smaller, more durable and reliable, with fewer adverse events. However, mechanical circulatory support devices that are currently being used continue to have considerable risks and hemodynamic complications associated with them including bleeding, stroke, and intra-pump thrombus formation. Many factors influence the occurrence of these adverse events in patients receiving mechanical circulatory support devices, including patient selection, patient management such as the anticoagulation regimen used, pump selection, surgical placement and implantation of the pump, and mechanical aspects of the pump including pump speed and pulsatility, among other factors. The existence of multiple factors and complexities influencing and contributing to these adverse event outcomes preclude a standard clinical trial approach.

Name of idea submitter and other team members who worked on this idea NHLBI Staff

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4 net votes
15 up votes
11 down votes
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Goal 3: Advance Translational Research

Engineering Challenges for Next Generation VADs

Critical challenges to overcome include the development of non-platelet activating impellers and hypothrombogenic surfaces in modern ventricular assist devices (VADs). Percutaneous and transcutaneous electric drive systems will need to evolve, and clinical research is needed to reduce thromboembolism and bleeding (acquired von Willebrand syndrome). Adverse events may also be further reduced if smaller pumps, for partial... more »

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Details on the impact of addressing this CQ or CC

It would improve quality of life for VAD recipients by reducing or eliminating their need to lifelong anticoagulant medication.

Feasibility and challenges of addressing this CQ or CC

There have been steady incremental improvements in all the challenge areas, and there are already many patients who do not encounter problems. A convergence and focusing of research efforts is needed.
Use of modern ventricular assist devices (VADs) has been associated with improvements in survival. However, INTERMACS has revealed that many of the adverse events associated with VADs stem from bio-incompatibilities between the device and patient.

Name of idea submitter and other team members who worked on this idea NHLBI Staff

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6 net votes
27 up votes
21 down votes
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Goal 3: Advance Translational Research

Risk Mitigation of Implantable Cardiovascular Devices

There is a serious need to improve implantable cardiovascular devices to eliminate, or at least substantially reduce, the risk of serious adverse events from occurring to more effectively treat patients.

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Details on the impact of addressing this CQ or CC

Cardiovascular devices would be more widely used to treat such cardiovascular diseases as heart failure, coronary artery disease, valvular disease and, therefore, have a greater public health benefit. Furthermore, costs associated with treating the serious adverse events (e.g. hospitalizations, therapeutics, etc.) would decrease.

Feasibility and challenges of addressing this CQ or CC

Technologies such as surface coatings and topographies as well as evolved design tools are under development already or are being used to mitigate the risks of devices currently being used or under development. A more concerted effort to do this would almost certainly help to substantially reduce the risks further, especially over the next 5-10 years.
Despite the widespread and growing use of implantable cardiovascular devices such as ventricular assist devices, stents, and prosthetic heart valves, substantial serious adverse events such as infections, neurological events, and bleeding limits the efficacy and use of the devices. Scientific and technological breakthroughs in such areas as biomaterials, design tools, coatings, and concomitant pharmacologic therapy are needed to address this challenge.

Name of idea submitter and other team members who worked on this idea NHLBI Staff

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-14 net votes
9 up votes
23 down votes
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Goal 2: Reduce Human Disease

Regeneration of Failing Heart while Resting on Left Ventricular Assist Device

Heart transplant is the ultimate treatment for AHA stage-D heart failure. Due to availability, heart transplants will be limited to about 2,500 per year. Patients with AHA stage-D heart failure has estimated prevalence of 0.2% for age >45. Thus, patients in need far exceed organs available. A failed heart has very challenging environment for cellular therapy. Left ventricular assist device (LVAD) can offload the heart... more »

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea Carl Tong

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-4 net votes
3 up votes
7 down votes
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