Left ventricular vs. biventricular mechanical support: Decision making and strategies for avoidance of right heart failure after left ventricular assist device implantation

Dandel, Michael; Krabatsch, Thomas; Falk, Volkmar

doi:10.1016/j.ijcard.2015.06.103

Cited by 70 publications

(56 citation statements)

References 71 publications

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“…Because of the multifactorial nature of RHF after LVAD, 4,5 83 parameters of clinical relevance are examined in this study for possible association with early post-LVAD RHF.…”

Section: Risk Score Componentsmentioning

confidence: 99%

“…3 The pathophysiology of RHF, however, is not well known. 4,5 Post-LVAD RHF has been reported to be between 4% and 50%, [6][7][8][9][10] and RHF-associated 6-month mortality was seen in up to 29% of patients receiving an LVAD. 11 Moreover, RHF has a greater impact in patients who receive LVAD as DT, for whom there is no opportunity for bailout with heart transplantation.…”

mentioning

confidence: 99%

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Derivation and Validation of a Novel Right-Sided Heart Failure Model After Implantation of Continuous Flow Left Ventricular Assist Devices

Soliman¹,

Akın

Muslem³

et al. 2018

Circulation

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198

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ARTICLE ORIGINAL RESEARCH ARTICLEEditorial, see p XXX BACKGROUND: The aim of the study was to derive and validate a novel risk score for early right-sided heart failure (RHF) after left ventricular assist device implantation. METHODS:The European Registry for Patients with Mechanical Circulatory Support (EUROMACS) was used to identify adult patients undergoing continuous-flow left ventricular assist device implantation with mainstream devices. Eligible patients (n=2988) were randomly divided into derivation (n=2000) and validation (n=988) cohorts. The primary outcome was early (<30 days) severe postoperative RHF, defined as receiving short-or long-term rightsided circulatory support, continuous inotropic support for ≥14 days, or nitric oxide ventilation for ≥48 hours. The secondary outcome was all-cause mortality and length of stay in the intensive care unit. Covariates found to be associated with RHF (exploratory univariate P<0.10) were entered into a multivariable logistic regression model. A risk score was then generated using the relative magnitude of the exponential regression model coefficients of independent predictors at the last step after checking for collinearity, likelihood ratio test, c index, and clinical weight at each step.RESULTS: A 9.5-point risk score incorporating 5 variables (Interagency Registry for Mechanically Assisted Circulatory Support class, use of multiple inotropes, severe right ventricular dysfunction on echocardiography, ratio of right atrial/ pulmonary capillary wedge pressure, hemoglobin) was created. The mean scores in the derivation and validation cohorts were 2.7±1.9 and 2.6±2.0, respectively (P=0.32). RHF in the derivation cohort occurred in 433 patients (21.7%) after left ventricular assist device implantation and was associated with a lower 1-year (53% versus 71%; P<0.001) and 2-year (45% versus 58%; P<0.001) survival compared with patients without RHF. RHF risk ranged from 11% (low risk score 0-2) to 43.1% (high risk score >4; P<0.0001). Median intensive care unit stay was 7 days (interquartile range, 4-15 days) versus 24 days (interquartile range, 14-38 days) in patients without versus with RHF, respectively (P<0.001). The c index of the composite score was 0.70 in the derivation and 0.67 in the validation cohort. The EUROMACS-RHF risk score outperformed (P<0.0001) previously published scores and known individual echocardiographic and hemodynamic markers of RHF. CONCLUSIONS:This novel EUROMACS-RHF risk score outperformed currently known risk scores and clinical predictors of early postoperative RHF. This novel score may be useful for tailored risk-based clinical assessment and management of patients with advanced HF evaluated for ventricular assist device therapy. 1,2 Early post-LVAD mortality is due partly to the development of right-sided HF (RHF) in the early post-LVAD phase. 3 The pathophysiology of RHF, however, is not well known.4,5 Post-LVAD RHF has been reported to be between 4% and 50%, 6-10 and RHF-associated 6-month mortality was seen in up to 29% of patients ...

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“…Because of the multifactorial nature of RHF after LVAD, 4,5 83 parameters of clinical relevance are examined in this study for possible association with early post-LVAD RHF.…”

Section: Risk Score Componentsmentioning

confidence: 99%

mentioning

confidence: 99%

Derivation and Validation of a Novel Right-Sided Heart Failure Model After Implantation of Continuous Flow Left Ventricular Assist Devices

Soliman¹,

Akın

Muslem³

et al. 2018

Circulation

Self Cite

198

View full text Add to dashboard Cite

show abstract

“…[7][8][9][10][11][12][13][14][15][16][17][18][19] Several studies have identified varying risk factors for developing right ventricular failure after LVAD placement based on patient characteristics, hemodynamic factors, laboratory data, and echocardiographic imaging. A ventricular assist device is indicated for use as a bridge to transplantation, destination therapy, or a bridge to myocardial recovery.…”

Section: Indications For Total Artificial Heart Implantationmentioning

confidence: 99%

Perioperative Care of the Patient With the Total Artificial Heart

Yaung

Arabía

Nurok

2017

Anesthesia &Amp; Analgesia

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Advanced heart failure continues to be a leading cause of morbidity and mortality despite improvements in pharmacologic therapy. High demand for cardiac transplantation and shortage of donor organs have led to an increase in the utilization of mechanical circulatory support devices. The total artificial heart is an effective biventricular assist device that may be used as a bridge to transplant and that is being studied for destination therapy. This review discusses the history, indications, and perioperative management of the total artificial heart with emphasis on the postoperative concerns.

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“…39 An increased cardiac output from the LVAD increases venous return to the RV and can also pull the shared inter-ventricular septum away from the RV free wall, aggravating possible preexisting RV dysfunction. 39 An increased cardiac output from the LVAD increases venous return to the RV and can also pull the shared inter-ventricular septum away from the RV free wall, aggravating possible preexisting RV dysfunction.…”

Section: Rv Strain-derived Parameters Cutoff Value; Hazard Ratio (Hr)mentioning

confidence: 99%

“…placement is common (up to 40% of cases) and is associated with increased perioperative mortality and poor quality of life. 39 An increased cardiac output from the LVAD increases venous return to the RV and can also pull the shared inter-ventricular septum away from the RV free wall, aggravating possible preexisting RV dysfunction. In contrast to TAPSE and RVFAC, RV strain applied in studies with 19 and 117 patients was able to accurately predict RV failure (RVFWLS ≥−11.5%, sensitivity of 100%, specificity of 90%, AUC=0.93).…”

Section: Right Ventricle Failure After Left Ventricular Assist Devicementioning

confidence: 99%

Added clinical value of applying myocardial deformation imaging to assess right ventricular function

Sokalskis¹,

Peluso

Jagodzinski³

et al. 2017

Echocardiography

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Right heart dysfunction has been found to be a strong prognostic factor predicting adverse outcome in various cardiopulmonary diseases. Conventional echocardiographic measurements can be limited by geometrical assumptions and impaired reproducibility. Speckle tracking-derived strain provides a robust quantification of right ventricular function. It explicitly evaluates myocardial deformation, as opposed to tissue Doppler-derived strain, which is computed from tissue velocity gradients. Right ventricular longitudinal strain provides a sensitive tool for detecting right ventricular dysfunction, even at subclinical levels. Moreover, the longitudinal strain can be applied for prognostic stratification of patients with pulmonary hypertension, pulmonary embolism, and congestive heart failure. Speckle tracking-derived right atrial strain, right ventricular longitudinal strain-derived mechanical dyssynchrony, and three-dimensional echocardiography-derived strain are emerging imaging parameters and methods. Their application in research is paving the way for their clinical use.

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Left ventricular vs. biventricular mechanical support: Decision making and strategies for avoidance of right heart failure after left ventricular assist device implantation

Cited by 70 publications

References 71 publications

Derivation and Validation of a Novel Right-Sided Heart Failure Model After Implantation of Continuous Flow Left Ventricular Assist Devices

Derivation and Validation of a Novel Right-Sided Heart Failure Model After Implantation of Continuous Flow Left Ventricular Assist Devices

Perioperative Care of the Patient With the Total Artificial Heart

Added clinical value of applying myocardial deformation imaging to assess right ventricular function

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