Can Perioperative Right Ventricular Support Prevent Postoperative Right Heart Failure in Patients With Biventricular Dysfunction Undergoing Left Ventricular Assist Device Implantation?

Deschka, Heinz; Holthaus, Alexander J.; Sindermann, Jürgen R.; Welp, Henryk; Schlarb, Dominik; Monsefi, Nadejda; Martens, Sven; Scherer, M.

doi:10.1053/j.jvca.2016.02.023

Cited by 40 publications

(41 citation statements)

References 29 publications

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“…Further, RVF risk modeling identifies patients that may benefit from a planned upfront biventricular support strategy -either as bridge-to-transplant or as temporary peri-operative RV support -both of which may be associated with favorable outcomes. (37)(38)(39) In this study, the superior predictive strength of the Michigan risk score highlights the importance of pre-operative target end-organ dysfunction in the risk of developing RVF post-LVAD implantation. Admittedly, multiple end-organ dysfunction is not confined to indicating impending right ventricular failure and can also be reflective of a more global critical illness such as severe sepsis.…”

Section: Discussionmentioning

confidence: 86%

Comparative Analysis of Established Risk Scores and Novel Hemodynamic Metrics in Predicting Right Ventricular Failure in Left Ventricular Assist Device Patients

Peters

Smith

Ababio

et al. 2019

Journal of Cardiac Failure

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Background-Right ventricular failure (RVF) portends poor outcomes after left ventricular assist device (LVAD) implantation. Although numerous RVF predictive models have been developed, there are few independent comparative analyses of these risk models. Methods and Results-Patients implanted with LVADs from 2011 to 2016 at the University of Virginia were retrospectively reviewed. RVF was defined as use of inotropes for >14 days, inhaled pulmonary vasodilators for >48 hours or unplanned right ventricular mechanical support postoperatively during the index hospitalization. Risk models were evaluated for the primary outcome of RVF using logistic regression and receiver operating curves. Among 93 LVAD patients with complete data, the Michigan RVF score (c-statistic 0.7374) compared favorably with newer RVF risk scores (Utah, Pitt, Euromacs) and was also superior to individual hemodynamic/ echocardiographic metrics including pulmonary artery pulsatility index (PAPi), pre-operative right ventricular dysfunction (RVD), right atrial pressure, and pulmonary vascular resistance. The Michigan RVF score was also the best predictor of in-hospital mortality (c-statistic 0.6729) and long-term survival (Kaplan-Meier log-rank 0.0135). Conclusions-While several new models and metrics provide predictive value, the more established Michigan RVF score-which emphasizes pre-operative hemodynamic instability and target end-organ dysfunction-remains a superior predictor of postoperative RVF as well as shortterm and long-term mortality.

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Section: Discussionmentioning

confidence: 86%

Comparative Analysis of Established Risk Scores and Novel Hemodynamic Metrics in Predicting Right Ventricular Failure in Left Ventricular Assist Device Patients

Peters

Smith

Ababio

et al. 2019

Journal of Cardiac Failure

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“…More than 40% of heart transplantation has been performed in patients with LVAD according to ISHLT registry data (7). However, in some clinical situations, it is impossible for LVAD to significantly improve hemodynamics such as biventricular CHF (8).…”

Section: Original Articlementioning

confidence: 99%

Five years’ experience with a peripheral veno-arterial ECMO for mechanical bridge to heart transplantation

Попцов¹,

Спирина²,

Догонашева³

et al. 2019

J. Thorac. Dis

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Background: Mechanical circulatory support (MCS) is the only way to save a life for heart transplant candidates and to decrease of waiting list mortality. The choice between short-or long-term pretransplant MCS depends on of type and severity of CHF. One of the most frequently used methods of temporary MSC before orthotopic heart transplantation (OHTx) is veno-arterial extracorporeal membrane oxygenation (VA ECMO). The aim of this study was to analyze own experience of peripheral VA ECMO (pVA ECMO) in heart transplant candidates needed in urgent HT. Methods: This study included 182 pts [160 (87.9%) men and 22 (12.1%) female, age 43±1.2 yrs] supported with pVA ECMO in the period from 01. 01. 2013 to 31. 12. 2017 or 23.2% from all waiting list (n=786). Results: During VA ECMO, 16 (8.8%) of the 182 pts died. In most pts [n=13 (81.3%)] multiorgan failure/sepsis were the cause of death. One hundred and sixty-six (91.2%) pts were successfully bridged to OHTx or 27.9% from all heart transplant recipients (n=594) (2013-2017 yrs). The duration of pVA ECMO before OHTx (n=166) was 5.8±3.2 days. One hundred and forty-three (86.1%) from 166 pts were discharged to home. Post-transplant survival among heart transplant recipient with pre-transplant MCS by pVA ECMO was in comparison with recipients without pretransplant MCS [84.2% vs. 90.1% (6 months), 83.3% vs. 91.8% (1 years), 75.1% vs. 86.1% (2 years), 74.2% vs. 85.8% (3 years), 72.3% vs. 84.7% (4 years), 72.3% vs. 83.5% (5 years) respectively (P<0.0001)]. Conclusions: pVA ECMO is a useful tool of treatment of patients with INTERMACS profile 1/2. Results of OHTx at recipients bridged with VA ECMO are less successful that recipients without pre-transplant MCS. VA ECMO should be considered as a direct bridge to OHTx in conditions of limited financial resources of health care and high availability of donor's hearts.

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“…Bei medikamentös therapierefraktärem Rechtsherzversagen besteht die Möglichkeit, die Patienten mit einem temporären rechtsventrikulären Unterstützungssystem zu stabilisieren. Einige Studien konnten mit diesem Vorgehen ein verbessertes Outcome der LVAD-Patienten nachweisen [55]. Als Neuromonitoring hat sich bei Patienten zur LVAD-Implantation der Einsatz der NIRS-Technologie etabliert [56].…”

Section: Merkeunclassified

Kardioanästhesie: anästhesiologisches Management

Renner¹,

Bein²,

Broch³

2018

Anästhesiol Intensivmed Notfallmed Schmerzther

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The anaesthesiological management of patients scheduled for cardiac surgery has been refined distinctively over the last decade due to different reasons. The continuing growth of the elderly patient population and the increasing number of combined cardiac surgery procedures in octogenarians on the one hand are one aspect. The rapid development of minimally invasive cardiac surgery and the enhancements in mechanical, artificial heart assist devices on the other hand can be seen as additional decisive factors. All of these innovations in the field of cardiac surgery implicate further enhancements regarding the anaesthesiological management. This review article addresses the following subareas of cardiac anaesthesia: significance of pharmacological myocardial protection, anaesthetic management during cardiopulmonary bypass, importance of "Enhanced Recovery After Cardiac Surgery"-protocols as well as innovations in the field of minimally invasive cardiac surgery like transcatheter aortic valve implantation.

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Can Perioperative Right Ventricular Support Prevent Postoperative Right Heart Failure in Patients With Biventricular Dysfunction Undergoing Left Ventricular Assist Device Implantation?

Cited by 40 publications

References 29 publications

Comparative Analysis of Established Risk Scores and Novel Hemodynamic Metrics in Predicting Right Ventricular Failure in Left Ventricular Assist Device Patients

Comparative Analysis of Established Risk Scores and Novel Hemodynamic Metrics in Predicting Right Ventricular Failure in Left Ventricular Assist Device Patients

Five years’ experience with a peripheral veno-arterial ECMO for mechanical bridge to heart transplantation

Kardioanästhesie: anästhesiologisches Management

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