Combination Evaluation of Preoperative Risk Indices Predicts Requirement of Biventricular Assist Device

Abstract

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp utcomes after implantation of pulsatile left ventricular assist device (LVAD) appear to have been critically dependent on postoperative right ventricular (RV) function. 1-3 Recent innovations of LVAD pumps have dramatically decreased device-related complications and improved overall prognosis, 4-7 but postoperative RV failure is still a serious concern even in the era of continuous flow pumps. 7,8 Editorial p 2740Generally speaking, open heart surgery using cardiopulmonary bypass is often associated with postoperative RV dysfunction even if preoperative RV function is apparently normal. Postoperative RV failure usually manifests perioperatively or soon after surgery, but resolves within 1-2 weeks in most cases, but sometimes requires i.v. inotropes for >2 weeks and/or inhalation of nitric oxide for >48 h. In more severe cases of RV failure, mechanical support for RV with extracorporeal membrane oxygenation (ECMO) is necessary, albeit temporary. Furthermore, the implantation of RV assist device (RVAD) is an extreme and prolonged form of mechanical support of RV. The aforedescribed requirements of inotropes to RVAD are in fact the definition of postoperative RV failure, 1-3 which is thought to be a manifestation of pre-existing intrinsic RV impairment during the perioperative period.If patients with LVAD implantation have severe RV failure, biventricular assist device (BiVAD) is occasionally necessary, but those who require BiVAD have an extremely poor prognosis, 9 as we have also reported. 10 In this regard, proper and precise identification of patients at high risk for RV failure is indispensable. Thus far, many investigators have reported preoperative risk factors for RV failure. Combination Evaluation of Preoperative Risk Indices Predicts Requirement of Biventricular Assist Device

Quality of Life and Influential Factors in Patients Implanted With a Left Ventricular Assist Device

“…12,15,16 Despite significant advances in device technology and pre-and postoperative care, RVF remains a major cause of death, higher rate of re-operation for bleeding and renal failure, and longer hospital stay. 12,15, 16 Our study expands these findings and highlights the importance of appropriate RVF management and prevention to improve patients' QOL as well as clinical outcomes.…”

Novel Method of Evaluating Liver Stiffness Using Transient Elastography to Evaluate Perioperative Status in Severe Heart Failure

“…Some reports have described the importance of CVP/ PCWP as a predictor of RVAD in patients undergoing LVAD implantation. 28 In the present study, we did not find a relationship between CVP/PCWP and RVAD requirement, which may have been due to the small number of patients who required RVAD.…”

Late-Onset Right Ventricular Failure in Patients With Preoperative Small Left Ventricle After Implantation of Continuous Flow Left Ventricular Assist Device

“…All patients were classified based on the interagency registry for mechanically assisted circulatory support (INTERMACS). Several scoring systems to predict early RVF or prognosis after implantation of LVAD were calculated preoperatively: RVF risk score (RVFRS), 6 todai right ventricular failure score (TRV score), 14 and todai ventricular assist device score (TVAD score). 21 RVFRS was calculated from several indexes, including usage of vasopressor, serum aspartate aminotransferase >80 IU/L, serum total bilirubin >2.0 mg/dl, and serum creatinine >2.3 mg/dl, to predict early RVF after LVAD implantation.…”