Outcomes of left ventricular assist device implantation for advanced heart failure in critically ill patients (INTERMACS 1 and 2): A retrospective study

Zhigalov, Konstantin; Eynde, Jef Van den; Chrosch, Thomas; Goerdt, Lukas; Παπαθανασίου, Μαρία; Wendt, Daniel; Luedike, Peter; Pizanis, Nikolaus; Koch, Achim; Schmack, Bastian; Rassaf, Tienush; Kamler, Markus; Ruhparwar, Arjang; Weymann, Alexander

doi:10.1111/aor.13897

Cited by 10 publications

(11 citation statements)

References 24 publications

(28 reference statements)

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“…RHF is a significant complication in patients undergoing LVAD implantation, presenting in 20%–50% of all LVAD implantations. 12 Zhigalov et al 1 described a 16.8% incidence of severe RHF after LVAD implantation in patients presenting with INTERMACS profile I and II. In our cohort, we report a relatively similar rate (22.9%) of severe RHF, albeit in an unhealthier group of patients presenting with CS and INTERMACS profile I, and further supported with ECLS prior to LVAD implantation.…”

Section: Discussionmentioning

confidence: 99%

“…With the incremental development of expertise and knowledge in the field of surgical heart failure (HF) therapy, the overall mortality remains inadmissibly high, particularly in patients admitted in INTERMACS profile I and II, as according to the current classification of Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). 1 , 2 Whilst the ideal implant time of a durable assist device in patients with end-stage heart failure is considered prior to their development of cardiogenic shock (CS), the gold standard treatment of patients that present with refractory CS remains controversial. 3 In the annual INTERMACS report, the authors describe that prior to durable left-ventricular assist device (LVAD) implantation, 50% of the patients presented with INTERMACS profile I or II.…”

Section: Introductionmentioning

confidence: 99%

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Rescue extracorporeal life support as a bridge to durable left ventricular assist device

et al. 2021

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Background: The ideal timing of a durable assist device implantation in patients with end-stage heart failure presenting with INTERMACS profile I is still controversial. The data on extracorporeal life support (ECLS) bridge to durable left ventricular assist device (LVAD) in these patients is limited. Materials and methods: We retrospectively analyzed the outcomes of 35 patients in acute cardiogenic shock (CS) who, between December 2013 and September 2020, were bridged with ECLS to durable LVAD. The mean age was 52.3 ± 12.0 years. The primary endpoints of this study were in-hospital, 30-day, 6-month, and 1-year mortality. The secondary endpoint was the development of any postoperative adverse events and other characteristics during the follow-up period. We also assessed the impact of the rescue ECLS on the recovery of the end-organ function. Results: In-hospital, 30-day, 6-month, and 1-year survival was 65.6%, 75.9%, 69.2%, and 62.7% respectively. The median time on ECLS was 7 days (IQR 5.0–13.0). We observed a high incidence of a severe right heart failure (22.9%), acute kidney injury on dialysis (68.6%), and respiratory failure (77.1%). Bridge with ECLS provided a significant recovery of liver and kidney function prior to durable LVAD implantation. Conclusion: The concept of bridging patients presenting in end-stage heart failure and cardiogenic shock with ECLS prior to durable LVAD implantation is a feasible method to ensure acceptable survival rates and significant recovery of the end-organ function.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Rescue extracorporeal life support as a bridge to durable left ventricular assist device

et al. 2021

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“…Importantly, successful heart transplantation or LVAD implantation relies on timely referral of patients before irreversible end-organ damage occurs. 11,12 The referral process has not been well investigated, but studies have demonstrated that potential candidates for heart transplantation or LVADs are often missed or referred too late. [13][14][15] The reasons for late or no referral are largely unknown but may include difficulties in recognizing lack of treatment effect of standard HF therapy and unawareness of current outcomes following LVAD implantation.…”

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confidence: 99%

Socioeconomic Disparities in Referral for Invasive Hemodynamic Evaluation for Advanced Heart Failure: A Nationwide Cohort Study

Larsson

Kristensen

Madelaire

et al. 2021

Circ: Heart Failure

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Background: Factors determining referral for advanced heart failure (HF) evaluation are poorly studied. We studied the influence of socioeconomic aspects on the referral process in Denmark, which has a taxpayer-funded national health care system. Methods: We identified all patients aged 18 to 75 years with a first diagnosis of HF during 2010 to 2018. Hospitalized patients had to be discharged alive and were then followed for the outcome of undergoing a right heart catheterization (RHC) used as a surrogate marker of advanced HF work-up. Results: Of 36 637 newly diagnosed patients with HF, 680 (1.9%) underwent RHC during the follow-up period (median time to RHC of 280 days [interquartile range, 73–914]). Factors associated with a higher likelihood of RHC included the highest versus lowest household income quartile (HR, 1.56 [95% CI, 1.19–2.06]; P =0.001), being diagnosed with HF at a tertiary versus nontertiary hospital (HR, 1.68 [95% CI, 1.37–2.05]; P <0.001) and during a hospitalization versus outpatient visit (HR, 1.67 [95% CI, 1.42–1.95]; P <0.001). Level of education, occupational status, and distance to tertiary hospital were not independently associated with RHC. Older age, cancer, and a psychiatric diagnosis were independently associated with a decreased probability of RHC. Conclusions: Higher household income, HF diagnosis during hospitalization, and first admission at a tertiary hospital were associated with increased likelihood of subsequent referral for RHC independent of other demographic and clinical variables. Greater attention may be required to ensure timely referral for advanced HF therapies in lower income groups.

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“…A recent study of patients who received either HM3 or HVAD LVAD as INTERMACS-1 or INTERMACS-2 found a similar rate of RHF in 74 of 107 patients (69.2%). 22 Our study includes notable limitations. The effect of anesthesia induction and PPV are not only specific to patients receiving LVAD.…”

Section: Discussionmentioning

confidence: 96%

“…A recent study of patients who received either HM3 or HVAD LVAD as INTERMACS-1 or INTERMACS-2 found a similar rate of RHF in 74 of 107 patients (69.2%). 22…”

Section: Discussionmentioning

confidence: 99%

Effect of Anesthesia Induction on Cardiac Hemodynamics in Patients Undergoing Durable Left Ventricular Assist Device Implantation: The EACH-LVAD Study

Schurr,

Sigal,

Usman

et al. 2023

ASAIO Journal

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Right ventricular (RV) dysfunction is common after left ventricular assist device (LVAD) implantation leading to clinical right heart failure (RHF) associated with worsened survival and quality of life. It is likely that intraoperative events such as anesthesia induction play a role in the development or unmasking of RV dysfunction in addition to known effects from hemodynamic changes that occur after LVAD implantation. The EACH-LVAD Study is a prospective, single-center, single-arm, observational cohort study of adult patients with advanced heart failure undergoing durable LVAD implantation with standard anesthesia induction. Intraoperative RV hemodynamics via central venous pressure, mean pulmonary artery pressure, pulmonary artery pulsatility index, and vasoactive-inotropic score (a simple weighted summation of standardized drug doses) and echocardiographic parameters (RV fractional area change, RV area in diastole, RV basal diameter, septum position, RV function, tricuspid regurgitation) were measured and compared at prespecified timepoints, including postinduction. Postoperative clinical RHF was determined based on published definitions. Forty-two patients receiving a first-time LVAD were included between September 2017 and March 2019. Propofol-based induction was used in 31 patients and etomidate-based induction in eight patients. A significant increase in central venous pressure (CVP; p < 0.001), mean pulmonary artery pressure (mPAP; p < 0.001), and vasoactive inotropic score (VIS; p < 0.001) with associated decrease in pulmonary artery pulsatility index (PAPi; p < 0.001) was observed. Right ventricular function worsened throughout. Right heart failure occurred in 70% of patients. Propofol-based induction was not associated with a higher risk of RHF (relative risk [RR], 1.01 [95% confidence interval {CI}, 0.64–1.61]). The EACH-LVAD study demonstrates an effect of anesthesia induction on worsened RV hemodynamics and echocardiographic changes which may have an effect on the development of RHF.

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Outcomes of left ventricular assist device implantation for advanced heart failure in critically ill patients (INTERMACS 1 and 2): A retrospective study

Cited by 10 publications

References 24 publications

Rescue extracorporeal life support as a bridge to durable left ventricular assist device

Rescue extracorporeal life support as a bridge to durable left ventricular assist device

Socioeconomic Disparities in Referral for Invasive Hemodynamic Evaluation for Advanced Heart Failure: A Nationwide Cohort Study

Effect of Anesthesia Induction on Cardiac Hemodynamics in Patients Undergoing Durable Left Ventricular Assist Device Implantation: The EACH-LVAD Study

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