open access

Vol 29, No 2 (2022)
Review Article
Submitted: 2021-10-17
Accepted: 2021-12-03
Published online: 2021-12-28
Get Citation

Continuous-flow left ventricular assist device: Current knowledge, complications, and future directions

Javier Castrodeza12, Carlos Ortiz-Bautista12, Francisco Fernández-Avilés123
DOI: 10.5603/CJ.a2021.0172
·
Pubmed: 34967940
·
Cardiol J 2022;29(2):293-304.
Affiliations
  1. Cardiology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
  2. CIBER de Enfermedades Cardiovasculares (CIBER - CV), Spain
  3. Universidad Complutense, Madrid, Spain

open access

Vol 29, No 2 (2022)
Review articles — Interventional cardiology
Submitted: 2021-10-17
Accepted: 2021-12-03
Published online: 2021-12-28

Abstract

Long-term continuous-flow left ventricular assist devices have become a real alternative to heart transplantation in patients with advanced heart failure, achieving a promising 2-year event-free survival rate with new-generation devices. Currently, this technology has spread throughout the world, and any cardiologist or cardiac surgeon should be familiar with its fundamentals and its possible complications as well as the advances made in recent years. The aim of this review is to describe current knowledge, management of complications, and future directions of this novel heart-failure therapy

Abstract

Long-term continuous-flow left ventricular assist devices have become a real alternative to heart transplantation in patients with advanced heart failure, achieving a promising 2-year event-free survival rate with new-generation devices. Currently, this technology has spread throughout the world, and any cardiologist or cardiac surgeon should be familiar with its fundamentals and its possible complications as well as the advances made in recent years. The aim of this review is to describe current knowledge, management of complications, and future directions of this novel heart-failure therapy

Get Citation

Keywords

continuous flow, mechanical circulatory support, left ventricular assist device

About this article
Title

Continuous-flow left ventricular assist device: Current knowledge, complications, and future directions

Journal

Cardiology Journal

Issue

Vol 29, No 2 (2022)

Article type

Review Article

Pages

293-304

Published online

2021-12-28

Page views

6479

Article views/downloads

2285

DOI

10.5603/CJ.a2021.0172

Pubmed

34967940

Bibliographic record

Cardiol J 2022;29(2):293-304.

Keywords

continuous flow
mechanical circulatory support
left ventricular assist device

Authors

Javier Castrodeza
Carlos Ortiz-Bautista
Francisco Fernández-Avilés

References (100)
  1. McDonagh TA, Metra M, Adamo M, et al. ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021; 36: 3599–3726.
  2. Maddox TM, Januzzi JL, Allen LA, et al. 2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2021; 77(6): 772–810.
  3. Gustafsson F, Rogers JG. Left ventricular assist device therapy in advanced heart failure: patient selection and outcomes. Eur J Heart Fail. 2017; 19(5): 595–602.
  4. Rose E, Gelijns A, Moskowitz A, et al. Long-Term Use of a Left Ventricular Assist Device for End-Stage Heart Failure. N Engl J Med. 2001; 345(20): 1435–1443.
  5. Mehra MR, Uriel N, Naka Y, et al. A fully magnetically levitated left ventricular assist device - final report. N Engl J Med. 2019; 380(17): 1618–1627.
  6. Metra M, Eichhorn E, Abraham WT, et al. Effects of low-dose oral enoximone administration on mortality, morbidity, and exercise capacity in patients with advanced heart failure: the randomized, double-blind, placebo-controlled, parallel group ESSENTIAL trials. Eur Heart J. 2009; 30(24): 3015–3026.
  7. Lindenfeld J, Feldman AM, Saxon L, et al. Effects of cardiac resynchronization therapy with or without a defibrillator on survival and hospitalizations in patients with New York Heart Association class IV heart failure. Circulation. 2007; 115(2): 204–212.
  8. Goldstein DJ, Meyns B, Xie R, et al. Third annual report from the ISHLT mechanically assisted circulatory support registry: a comparison of centrifugal and axial continuous-flow left ventricular assist devices. J Heart Lung Transplant. 2019; 38(4): 352–363.
  9. Netuka I, Sood P, Pya Y, et al. Fully magnetically levitated left ventricular assist system for treating advanced HF: a multicenter study. J Am Coll Cardiol. 2015; 66(23): 2579–2589.
  10. Zimpfer D, Netuka I, Schmitto JD, et al. Multicentre clinical trial experience with the HeartMate 3 left ventricular assist device: 30-day outcomes. Eur J Cardiothorac Surg. 2016; 50(3): 548–554.
  11. Krabatsch T, Netuka I, Schmitto JD, et al. Heartmate 3 fully magnetically levitated left ventricular assist device for the treatment of advanced heart failure -1 year results from the Ce mark trial. J Cardiothorac Surg. 2017; 12(1): 23.
  12. Schmitto JD, Pya Y, Zimpfer D, et al. Long-term evaluation of a fully magnetically levitated circulatory support device for advanced heart failure-two-year results from the HeartMate 3 CE Mark Study. Eur J Heart Fail. 2019; 21(1): 90–97.
  13. Bourque K, Cotter C, Dague C, et al. Design rationale and preclinical evaluation of the heartmate 3 left ventricular assist system for hemocompatibility. ASAIO J. 2016; 62(4): 375–383.
  14. Lim HS, Howell N, Ranasinghe A. The physiology of continuous-flow left ventricular assist devices. J Card Fail. 2017; 23(2): 169–180.
  15. Miller LW, Rogers JG. Evolution of left ventricular assist device therapy for advanced heart failure: a review. JAMA Cardiol. 2018; 3(7): 650–658.
  16. Potapov EV, Netuka I, Kaufmann F, et al. Strategy for surgical correction and mitigation of outflow graft twist with a centrifugal-flow left ventricular assist system. J Heart Lung Transplant. 2018; 37(5): 670–673.
  17. Abbott Recalls the HeartMate 3TM Left Ventricular Assist System Due to Potential Malfunction that may Lead to Graft Occlusion. https://www.fda.gov/medical-devices/medical-device-recalls/abbott-recalls-heartmate-3tm-leftventricular-assist-system-due-potential malfunction-may-lead-graft..
  18. Rivas-Lasarte M, Scatola A, Sims DB, et al. A new twist to HeartMate 3 low flow alarms. Rev Esp Cardiol (Engl Ed). 2021; 74(4): 349–351.
  19. Hanke JS, Rojas SV, Dogan G, et al. First series of left ventricular assist device exchanges to HeartMate 3. Eur J Cardiothorac Surg. 2017; 51(5): 887–892.
  20. Saito S, Nishinaka T. Chronic nonpulsatile blood flow is compatible with normal end-organ function: implications for LVAD development. J Artif Organs. 2005; 8(3): 143–148.
  21. Uriel N, Adatya S, Malý J, et al. Clinical hemodynamic evaluation of patients implanted with a fully magnetically levitated left ventricular assist device (HeartMate 3). J Heart Lung Transplant. 2017; 36(1): 28–35.
  22. Dobarro D, Urban M, Booth K, et al. Impact of aortic valve closure on adverse events and outcomes with the HeartWare ventricular assist device. J Heart Lung Transplant. 2017; 36(1): 42–49.
  23. John R, Mantz K, Eckman P, et al. Aortic valve pathophysiology during left ventricular assist device support. J Heart Lung Transplant. 2010; 29(12): 1321–1329.
  24. Bartoli CR, Giridharan GA, Litwak KN, et al. Hemodynamic responses to continuous versus pulsatile mechanical unloading of the failing left ventricle. ASAIO J. 2010; 56(5): 410–416.
  25. Healy C, Viles-Gonzalez JF, Sacher F, et al. Management of ventricular arrhythmias in patients with mechanical ventricular support devices. Curr Cardiol Rep. 2015; 17(8): 59.
  26. Long B, Robertson J, Koyfman A, et al. Left ventricular assist devices and their complications: A review for emergency clinicians. Am J Emerg Med. 2019; 37(8): 1562–1570.
  27. Kiamanesh O, Kaan A, Toma M. Medical management of left ventricular assist device patients: a practical guide for the nonexpert clinician. Can J Cardiol. 2020; 36(2): 205–215.
  28. O'Horo JC, Abu Saleh OM, Stulak JM, et al. Left ventricular assist device infections: a systematic review. ASAIO J. 2018; 64(3): 287–294.
  29. Schlöglhofer T, Michalovics P, Riebandt J, et al. Left ventricular assist device driveline infections in three contemporary devices. Artif Organs. 2021; 45(5): 464–472.
  30. Blanco-Guzman MO, Wang X, Vader JM, et al. Epidemiology of left ventricular assist device infections: findings from a large nonregistry cohort. Clin Infect Dis. 2021; 72(2): 190–197.
  31. John R, Aaronson KD, Pae WE, et al. HeartWare Bridge to Transplant ADVANCE Trial Investigators. Drive-line infections and sepsis in patients receiving the HVAD system as a left ventricular assist device. J Heart Lung Transplant. 2014; 33(10): 1066–1073.
  32. Shah P, Mehta VM, Cowger JA, et al. Diagnosis of hemolysis and device thrombosis with lactate dehydrogenase during left ventricular assist device support. J Heart Lung Transplant. 2014; 33(1): 102–104.
  33. Uriel N, Han J, Morrison KA, et al. Device thrombosis in HeartMate II continuous-flow left ventricular assist devices: a multifactorial phenomenon. J Heart Lung Transplant. 2014; 33(1): 51–59.
  34. Schrottmaier WC, Kral JB, Zeitlinger M, et al. Platelet activation at the onset of human endotoxemia is undetectable in vivo. Platelets. 2016; 27(5): 479–483.
  35. Park SJ, Milano CA, Tatooles AJ, et al. Outcomes in advanced heart failure patients with left ventricular assist devices for destination therapy. Circ Heart Fail. 2012; 5(2): 241–248.
  36. Feldman D, Pamboukian SV, Teuteberg JJ, et al. The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant. 2013; 32(2): 157–187.
  37. Cagliostro B, Levin AP, Fried J, et al. Continuous-flow left ventricular assist devices and usefulness of a standardized strategy to reduce drive-line infections. J Heart Lung Transplant. 2016; 35(1): 108–114.
  38. Kimura Y, Seguchi O, Mochizuki H, et al. Role of Gallium-SPECT-CT in the Management of Patients With Ventricular Assist Device-Specific Percutaneous Driveline Infection. J Card Fail. 2019; 25(10): 795–802.
  39. Koval CE, Stosor V. AST ID Community of Practice. Ventricular assist device-related infections and solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019; 33(9): e13552.
  40. Aslam S. Ventricular assist device infections. Cardiol Clin. 2018; 36(4): 507–517.
  41. Truby LK, Garan AR, Givens RC, et al. Aortic insufficiency during contemporary left ventricular assist device support: analysis of the INTERMACS registry. JACC Heart Fail. 2018; 6(11): 951–960.
  42. Jorde UP, Uriel N, Nahumi N, et al. Prevalence, significance, and management of aortic insufficiency in continuous flow left ventricular assist device recipients. Circ Heart Fail. 2014; 7(2): 310–319.
  43. Pak SW, Uriel N, Takayama H, et al. Prevalence of de novo aortic insufficiency during long-term support with left ventricular assist devices. J Heart Lung Transplant. 2010; 29(10): 1172–1176.
  44. Kirklin JK, Pagani FD, Goldstein DJ, et al. Editors, Contributing Authors, Reviewers. American Association for Thoracic Surgery/International Society for Heart and Lung Transplantation guidelines on selected topics in mechanical circulatory support. J Heart Lung Transplant. 2020; 39(3): 187–219.
  45. Imamura T, Narang N, Kim G, et al. Impact of worsening of aortic insufficiency during HeartMate 3 LVAD support. Artif Organs. 2021; 45(3): 297–302.
  46. Kiamanesh O, Kaan A, Toma M. Medical management of left ventricular assist device patients: a practical guide for the nonexpert clinician. Can J Cardiol. 2020; 36(2): 205–215.
  47. Bhagra SK, Pettit S, Parameshwar J. Implantable left ventricular assist device: indications, eligibility and current outcomes. Heart. 2021 [Epub ahead of print].
  48. Yehya A, Rajagopal V, Meduri C, et al. Short-term results with transcatheter aortic valve replacement for treatment of left ventricular assist device patients with symptomatic aortic insufficiency. J Heart Lung Transplant. 2019; 38(9): 920–926.
  49. Fried JA, Nazif TM, Colombo PC. A new frontier for TAVR: Aortic insufficiency in CF-LVAD patients. J Heart Lung Transplant. 2019; 38(9): 927–929.
  50. van der Werf HW, Schurer RAj, Vonck TE, et al. Emergency transcatheter aortic valve implantation in patients with severe aortic regurgitation and a left ventricle assist device: A case report and systematic review. Eur Heart J Acute Cardiovasc Care. 2017; 6(8): 719–727.
  51. Parikh KS, Mehrotra AK, Russo MJ, et al. Percutaneous transcatheter aortic valve closure successfully treats left ventricular assist device-associated aortic insufficiency and improves cardiac hemodynamics. JACC Cardiovasc Interv. 2013; 6(1): 84–89.
  52. Cowger J, Rao V, Massey T, et al. Comprehensive review and suggested strategies for the detection and management of aortic insufficiency in patients with a continuous-flow left ventricular assist device. J Heart Lung Transplant. 2015; 34(2): 149–157.
  53. Bellavia D, Iacovoni A, Scardulla C, et al. Prediction of right ventricular failure after ventricular assist device implant: systematic review and meta-analysis of observational studies. Eur J Heart Fail. 2017; 19(7): 926–946.
  54. Cogswell R, John R, Shaffer A. Right ventricular failure after left ventricular assist device. Cardiol Clin. 2020; 38(2): 219–225.
  55. Benjamin MM, Sundararajan S, Sulaiman S, et al. Association of preoperative duration of inotropy on prevalence of right ventricular failure following LVAD implantation. ESC Heart Fail. 2020; 7(4): 1949–1955.
  56. Lampert BC, Teuteberg JJ. Right ventricular failure after left ventricular assist devices. J Heart Lung Transplant. 2015; 34(9): 1123–1130.
  57. Turner KR. Right ventricular failure after left ventricular assist device placement-the beginning of the end or just another challenge? J Cardiothorac Vasc Anesth. 2019; 33(4): 1105–1121.
  58. Ruiz-Cano MJ, Morshuis M, Koster A, et al. Risk factors of early right ventricular failure in patients undergoing LVAD implantation with intermediate Intermacs profile for advanced heart failure. J Card Surg. 2020; 35(8): 1832–1839.
  59. Ali HJR, Kiernan MS, Choudhary G, et al. Right ventricular failure post-implantation of left ventricular assist device: prevalence, pathophysiology, and predictors. ASAIO J. 2020; 66(6): 610–619.
  60. Lampert BC, Teuteberg JJ. Right ventricular failure after left ventricular assist devices. J Heart Lung Transplant. 2015; 34(9): 1123–1130.
  61. Raina A, Patarroyo-Aponte M. Prevention and treatment of right ventricular failure during left ventricular assist device therapy. Crit Care Clin. 2018; 34(3): 439–452.
  62. Mondal S, Sankova S, Lee K, et al. Intraoperative and early postoperative management of patients undergoing minimally invasive left ventricular assist device implantation. J Cardiothorac Vasc Anesth. 2021; 35(2): 616–630.
  63. Fitzpatrick JR, Frederick JR, Hiesinger W, et al. Early planned institution of biventricular mechanical circulatory support results in improved outcomes compared with delayed conversion of a left ventricular assist device to a biventricular assist device. J Thorac Cardiovasc Surg. 2009; 137(4): 971–977.
  64. Gopinathannair R, Cornwell WK, Dukes JW, et al. Device therapy and arrhythmia management in left ventricular assist device recipients: a scientific statement from the american heart association. Circulation. 2019; 139(20): e967–e989.
  65. Caraang C, Lanier GM, Gass A, et al. Left ventricular assist device in older adults. Heart Fail Clin. 2017; 13(3): 619–632.
  66. Bohonos CJ, Bechtum EL, Luckhardt AJ, et al. Ventricular tachycardia and preload deficiency post LVAD: the importance of integrated assessment. Heart Lung. 2020; 49(5): 481–487.
  67. Cantillon DJ, Tarakji KG, Kumbhani DJ, et al. Improved survival among ventricular assist device recipients with a concomitant implantable cardioverter-defibrillator. Heart Rhythm. 2010; 7(4): 466–471.
  68. Refaat MM, Tanaka T, Kormos RL, et al. Survival benefit of implantable cardioverter-defibrillators in left ventricular assist device-supported heart failure patients. J Card Fail. 2012; 18(2): 140–145.
  69. Enriquez AD, Calenda B, Miller MA, et al. The role of implantable cardioverter-defibrillators in patients with continuous flow left ventricular assist devices. Circ Arrhythm Electrophysiol. 2013; 6(4): 668–674.
  70. Garan AR, Yuzefpolskaya M, Colombo PC, et al. Ventricular arrhythmias and implantable cardioverter-defibrillator therapy in patients with continuous-flow left ventricular assist devices: need for primary prevention? J Am Coll Cardiol. 2013; 61(25): 2542–2550.
  71. Lee W, Tay A, Subbiah RN, et al. Impact of implantable cardioverter defibrillators on survival of patients with centrifugal left ventricular assist devices. Pacing Clin Electrophysiol. 2015; 38(8): 925–933.
  72. Vakil K, Kazmirczak F, Sathnur N, et al. Implantable cardioverter-defibrillator use in patients with left ventricular assist devices: a systematic review and meta-analysis. JACC Heart Fail. 2016; 4(10): 772–779.
  73. Bartoli CR, Ghotra AS, Pachika AR, et al. Hematologic markers better predict left ventricular assist device thrombosis than echocardiographic or pump parameters. Thorac Cardiovasc Surg. 2014; 62(5): 414–418.
  74. Adatya S, Holley CT, Roy SS, et al. Echocardiographic Ramp test for continuous-flow left ventricular assist devices: do loading conditions matter? JACC Heart Fail. 2015; 3(4): 291–299.
  75. Kato TS, Colombo PC, Nahumi N, et al. Value of serial echo-guided ramp studies in a patient with suspicion of device thrombosis after left ventricular assist device implantation. Echocardiography. 2014; 31(1): E5–E9.
  76. Barac YD, Nevo A, Schroder JN, et al. LVAD outflow graft role in pump thrombosis. ASAIO J. 2020; 66(2): 128–131.
  77. Stulak JM, Sharma S, Maltais S. Management of pump thrombosis in patients with left ventricular assist devices. Am J Cardiovasc Drugs. 2015; 15(2): 89–94.
  78. Hanke JS, Dogan G, Wert L, et al. Left ventricular assist device exchange for the treatment of HeartMate II pump thrombosis. J Thorac Dis. 2018; 10(Suppl 15): S1728–S1736.
  79. Giede-Jeppe A, Roeder SS, Macha K, et al. Management of stroke in patients with left ventricular assist devices. J Stroke Cerebrovasc Dis. 2020; 29(11): 105166.
  80. Kuśmierczyk M, Różański J, Zembala M, et al. Heart failure in Poland: left ventricular assist device destination therapy and other challenges of interventional cardiology and cardiac surgery. Cardiol J. 2020; 27(6): 693–704.
  81. Netuka I, Ivák P, Tučanová Z, et al. Evaluation of low-intensity anti-coagulation with a fully magnetically levitated centrifugal-flow circulatory pump-the MAGENTUM 1 study. J Heart Lung Transplant. 2018; 37(5): 579–586.
  82. Kadakkal A, Najjar SS. Neurologic events in continuous-flow left ventricular assist devices. Cardiol Clin. 2018; 36(4): 531–539.
  83. Kataria R, Jorde UP. Gastrointestinal bleeding during continuous-flow left ventricular assist device support: state of the field. Cardiol Rev. 2019; 27(1): 8–13.
  84. Klovaite J, Gustafsson F, Mortensen SA, et al. Severely impaired von Willebrand factor-dependent platelet aggregation in patients with a continuous-flow left ventricular assist device (HeartMate II). J Am Coll Cardiol. 2009; 53(23): 2162–2167.
  85. Sakatsume Ko, Saito K, Akiyama M, et al. Association between the severity of acquired von Willebrand syndrome and gastrointestinal bleeding after continuous-flow left ventricular assist device implantation. Eur J Cardiothorac Surg. 2018; 54(5): 841–846.
  86. Crow S, Chen D, Milano C, et al. Acquired von Willebrand syndrome in continuous-flow ventricular assist device recipients. Ann Thorac Surg. 2010; 90(4): 1263–9; discussion 1269.
  87. Schmitto JD, Molitoris U, Haverich A, et al. Implantation of a centrifugal pump as a left ventricular assist device through a novel, minimized approach: upper hemisternotomy combined with anterolateral thoracotomy. J Thorac Cardiovasc Surg. 2012; 143(2): 511–513.
  88. Maltais S, Davis ME, Haglund N. Minimally invasive and alternative approaches for long-term LVAD placement: the Vanderbilt strategy. Ann Cardiothorac Surg. 2014; 3(6): 563–569.
  89. Reichart D, Brand CF, Bernhardt AM, et al. Analysis of minimally invasive left thoracotomy HVAD implantation: a single-center experience. Thorac Cardiovasc Surg. 2019; 67(3): 170–175.
  90. McGee E, Danter M, Strueber M, et al. Evaluation of a lateral thoracotomy implant approach for a centrifugal-flow left ventricular assist device: The LATERAL clinical trial. J Heart Lung Transplant. 2019; 38(4): 344–351.
  91. Wieselthaler GM, Klein L, Cheung AW, et al. Two-year follow up of the LATERAL clinical trial: a focus on adverse events. Circ Heart Fail. 2021; 14(4): e006912.
  92. Mohite PN, Sabashnikov A, Raj B, et al. Minimally invasive left ventricular assist device implantation: a comparative study. Artif Organs. 2018; 42(12): 1125–1131.
  93. Maltais S, Anwer LA, Tchantchaleishvili V, et al. Left lateral thoracotomy for centrifugal continuous-flow left ventricular assist device placement: an analysis from the mechanical circulatory support research network. ASAIO J. 2018; 64(6): 715–720.
  94. Pasrija C, Sawan MA, Sorensen E, et al. Less invasive left ventricular assist device implantation may reduce right ventricular failure. Interact Cardiovasc Thorac Surg. 2019; 29(4): 592–598.
  95. Kormos RL, Cowger J, Pagani FD, et al. The society of thoracic surgeons intermacs database annual report: evolving indications, outcomes, and scientific partnerships. J Heart Lung Transplant. 2019; 38(2): 114–126.
  96. Kocabeyoglu SS, Kervan U, Sert DE, et al. Is it Possible to Implant HeartMate 3 Less Invasively? New Pump, New Approach. Artif Organs. 2018; 42(12): 1132–1138.
  97. Dowling RD, Gray LA, Etoch SW, et al. Initial experience with the AbioCor implantable replacement heart system. J Thorac Cardiovasc Surg. 2004; 127(1): 131–141.
  98. Pae WE, Connell JM, Adelowo A, et al. Does total implantability reduce infection with the use of a left ventricular assist device? The LionHeart experience in Europe. J Heart Lung Transplant. 2007; 26(3): 219–229.
  99. Pya Y, Maly J, Bekbossynova M, et al. First human use of a wireless coplanar energy transfer coupled with a continuous-flow left ventricular assist device. J Heart Lung Transplant. 2019; 38(4): 339–343.
  100. Mehra MR, Gustafsson F. Left ventricular assist devices at the crossroad of innovation in advanced heart failure. J Card Fail. 2021; 27(11): 1291–1294.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., Grupa Via Medica, ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl