Implantation of Short-Term and Long-Term Right Ventricular Assist Devices

Caldeira, Christiano; Machado, Regimar Carla; Caldeira, Debora Castello Branco

doi:10.21470/1678-9741-2017-0021

Cited by 6 publications

(7 citation statements)

References 6 publications

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“…Additionally, the lack of Food and Drug Administration-approved durable RV MCS devices, historically poor outcomes in transplanted TAH patients (compared with LVAD or non-MCS patients), and our findings of favourable post-transplant outcomes support transplantation as the definitive treatment for patients with advanced ARVC. 19,31,32 Given that the average age of ARVC diagnosis is ~30 years, 6,12,18,19 the current data-with ARVC patients listed for HT at an average of 44 (±17) years-suggest that the need for transplantation occurs approximately one to two decades after diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Heart transplantation outcomes in arrhythmogenic right ventricular cardiomyopathy: a contemporary national analysis

et al. 2022

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Aims Heart failure is an increasingly recognized later stage manifestation of arrhythmogenic right ventricular cardiomyopathy (ARVC) that can require heart transplantation (HT) to appropriately treat. We aimed to study contemporary ARVC HT outcomes in a national registry. Methods and resultsThe United Network for Organ Sharing registry was queried for HT recipients from 1/1994 through 2/2020. ARVC patients were compared with non-ARVC dilated, restrictive, and hypertrophic cardiomyopathy HT patients (HT for ischaemic and valvular disease was excluded from analysis). Post-HT survival was assessed using Kaplan-Meier estimates. A total of 189 of 252 (75%) waitlisted ARVC patients (median age 48 years, 65% male) underwent HT, representing 0.3% of the total 65 559 HT during the study time period. Annual frequency of HT for ARVC increased significantly over time. ARVC patients had less diabetes (5% vs. 17%, P < 0.001), less cigarette use (15% vs. 23%, P < 0.001), lower pulmonary artery and pulmonary capillary wedge pressures, and lower cardiac output than the 33 659 non-ARVC patients (P < 0.001). Ventricular assist device use was significantly lower in ARVC patients (8% vs. 32%, P < 0.001); 1 and 5 year post-HT survival was 97% and 93% for ARVC vs. 95% and 82% for non-ARVC HT recipients (P < 0.001). On adjusted multivariable Cox regression, ARVC had decreased risk of post-HT death compared with non-ARVC aetiologies (hazard ratio 0.48, 95% confidence interval 0.28-0.82, P = 0.008). Patients with ARVC also had lower risk of death or graft failure than non-ARVC patients (hazard ratio 0.51, 95% confidence interval 0.32-0.81, P = 0.004). Conclusions In the largest series of HT in ARVC, we found that HT is increasingly performed in ARVC, with higher survival compared with other cardiomyopathy aetiologies. The right ventricular predominant pathophysiology may require unique considerations for heart failure management, including HT.

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Section: Discussionmentioning

confidence: 99%

Heart transplantation outcomes in arrhythmogenic right ventricular cardiomyopathy: a contemporary national analysis

et al. 2022

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“…There are currently no U.S. Food and Drug Administration (FDA)-approved long-term implantable devices designed to support the RV. Most reports of long-term RV support have been limited to off-label applications of devices designed and approved for the treatment of advanced LV failure, such as the HeartWare Ventricular Assist Device (HVAD; Heart-Ware, Framingham, MA) and the Heartmate 3 (St. Jude Medical, St. Paul, MN) ( 53 – 60 ). Other solutions have relied on adapting biventricular support devices for long-term RV support.…”

Section: The Evolution Of Percutaneous Right Ventricular Assist Devicesmentioning

confidence: 99%

Supporting the “forgotten” ventricle: The evolution of percutaneous RVADs

James

Smith

2023

Front. Cardiovasc. Med.

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Right heart failure (RHF) can occur as the result of an acute or chronic disease process and is a challenging clinical condition for surgeons and interventionalists to treat. RHF occurs in approximately 0.1% of patients after cardiac surgery, in 2–3% of patients following heart transplantation, and in up to 42% of patients after LVAD implantation. Regardless of the cause, RHF portends high morbidity and mortality and is associated with longer hospital stays and higher healthcare costs. The mainstays of traditional therapy for severe RHF have included pharmacological support, such as inotropes and vasopressors, and surgical right ventricular (RV) assist devices. However, in recent years catheter-based mechanical circulatory support (MCS) strategies have offered novel solutions for addressing RHF without the morbidity of open surgery. This manuscript will review the pathophysiology of RHF, including the molecular underpinnings, gross structural mechanisms, and hemodynamic consequences. The evolution of techniques for supporting the right ventricle will be explored, with a focus on various institutional experiences with percutaneous ventricular assist devices.

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“…There are currently no FDA-approved long-term implantable devices designed to provide RV support. 60 Most of the reported cases of LVADs being reconfigured ad-lib by clinicians for RV implantation have used the HeartWare device (Medtronic, Framingham, MA). 60 A review of the EUROMACS database published in 2015 noted 8 cases of isolated RVAD placement.…”

Section: Additional Mechanical Support Devices For Rv Supportmentioning

confidence: 99%

“…The Impella RP has been shown to decrease CVP while increasing cardiac output. 58,59 Although some authors report good outcomes, 60 the data for Impella RPs are mixed. One case series demonstrated overall survival at 30 days was 73.3% after placing an Impella RP, and all those who were discharged from the hospital were alive at 180 days.…”

Section: Impellamentioning

confidence: 99%

“…60 Most of the reported cases of LVADs being reconfigured ad-lib by clinicians for RV implantation have used the HeartWare device (Medtronic, Framingham, MA). 60 A review of the EUROMACS database published in 2015 noted 8 cases of isolated RVAD placement. Only 4 patients survived the first 30 days, with 2 being transplanted, 1 dying at day 44, and 1 patient recovering RV function.…”

Section: Right Ventricular Assist Devicesmentioning

confidence: 99%

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ECMO and Right Ventricular Failure: Review of the Literature

Grant¹,

Richards

Frakes³

et al. 2020

J Intensive Care Med

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Right ventricular (RV) failure is the inability of the RV to maintain sufficient cardiac output in the setting of adequate preload, due to either intrinsic injury to the RV or increased afterload. Medical treatment of RV failure should include optimizing preload, augmenting contractility with vasopressors and inotropes, and considering inhaled pulmonary vasodilators. However, when medical therapies are insufficient, mechanical circulatory support (MCS) is needed to maintain systemic and RV perfusion. The data on MCS for isolated RV failure are limited, but extracorporeal membrane oxygenation (ECMO) appears to be the most efficient and effective modality. For patients with isolated RV failure from acute hypoxemic respiratory failure, veno-venous (VV) ECMO is an appropriate initial configuration, even if the patient is in shock. With primary RV injury or RV failure with concomitant left ventricle (LV) failure, however, venoarterial (VA) ECMO is indicated. Both modalities provide indirect support to the RV by reducing preload, reducing RV wall tension, and delivering oxygenated blood to the coronary circulation. Peripheral cannulation is required in VV-ECMO and is most commonly used in VA-ECMO, allowing for rapid cannulation even in emergencies. Changes in pulsatility on an arterial catheter waveform can indicate changes in clinical status including changes in myocardial function, inadequate preload, worsening RV failure, and excessive VA-ECMO support leading to an elevated LV afterload. Myocardial function may be improved by titration of inotropes or vasodilators, utilization of an Impella or an intra-aortic balloon counterpulsation support devices, or by changes in VA-ECMO support.

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Implantation of Short-Term and Long-Term Right Ventricular Assist Devices

Cited by 6 publications

References 6 publications

Heart transplantation outcomes in arrhythmogenic right ventricular cardiomyopathy: a contemporary national analysis

Heart transplantation outcomes in arrhythmogenic right ventricular cardiomyopathy: a contemporary national analysis

Supporting the “forgotten” ventricle: The evolution of percutaneous RVADs

ECMO and Right Ventricular Failure: Review of the Literature

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