Recurrent Clotting of a Continuous-Flow Right Ventricular Assist Device—Repeated Thrombolysis With Two Different Protocols

Schürner, Anna Maria; Wilhelm, Markus J.; Falk, Volkmar; Ruschitzka, Frank; Béttex, Dominique; Rudiger, Alain

doi:10.1053/j.jvca.2014.11.013

Cited by 5 publications

(4 citation statements)

References 22 publications

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“…Retrospective reports have shown good results in terms of haemodynamic status and functional recovery enabling RVAD explantation in 42–75% of patients . Bleeding or thrombus formation are the most common complication related to RVADs . Poor left ventricular function usually predicts worse outcomes as isolated RVAD support under these circumstances is insufficient to improve systemic perfusion …”

Section: Clinical Managementmentioning

confidence: 99%

“…56,57 Bleeding or thrombus formation are the most common complication related to RVADs. 58 Poor left ventricular function usually predicts worse outcomes as isolated RVAD support under these circumstances is insufficient to improve systemic perfusion. 56 Despite case reports of prolonged RV support with an assist device intended for destination therapy, 59 options for long-term mechanical circulatory support have been lacking.…”

Section: Consider Transfer To Hospital With Possibility For Ecmo/mechmentioning

confidence: 99%

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Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology

Harjola

Mebazaa

Čelutkienė

et al. 2016

European J of Heart Fail

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519

427

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Acute right ventricular (RV) failure is a complex clinical syndrome that results from many causes. Research efforts have disproportionately focused on the failing left ventricle, but recently the need has been recognized to achieve a more comprehensive understanding of RV anatomy, physiology, and pathophysiology, and of management approaches. Right ventricular mechanics and function are altered in the setting of either pressure overload or volume overload. Failure may also result from a primary reduction of myocardial contractility owing to ischaemia, cardiomyopathy, or arrhythmia. Dysfunction leads to impaired RV filling and increased right atrial pressures. As dysfunction progresses 227to overt RV failure, the RV chamber becomes more spherical and tricuspid regurgitation is aggravated, a cascade leading to increasing venous congestion. Ventricular interdependence results in impaired left ventricular filling, a decrease in left ventricular stroke volume, and ultimately low cardiac output and cardiogenic shock. Identification and treatment of the underlying cause of RV failure, such as acute pulmonary embolism, acute respiratory distress syndrome, acute decompensation of chronic pulmonary hypertension, RV infarction, or arrhythmia, is the primary management strategy. Judicious fluid management, use of inotropes and vasopressors, assist devices, and a strategy focusing on RV protection for mechanical ventilation if required all play a role in the clinical care of these patients. Future research should aim to address the remaining areas of uncertainty which result from the complexity of RV haemodynamics and lack of conclusive evidence regarding RV-specific treatment approaches.

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Section: Clinical Managementmentioning

confidence: 99%

Section: Consider Transfer To Hospital With Possibility For Ecmo/mechmentioning

confidence: 99%

Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology

Harjola

Mebazaa

Čelutkienė

et al. 2016

European J of Heart Fail

Self Cite

519

427

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“…Among the clinical situations to be RVAD considered, we highlight RV myocardial infarction, PE, myocarditis, and postoperative low cardiac output syndrome, following LV assist device implantation or primary graft failure after heart transplantation [ 66 ]. Bleeding or thrombus formation is the most common complication related to RVADs [ 115 ]. ECMO support with either peripheral or central cannulation is indicated whenever respiratory failure is present while awaiting pulmonary recovery, with or without RVF or biventricular failure.…”

Section: Treatmentmentioning

confidence: 99%

Acute Right Ventricular Dysfunction in Intensive Care Unit

Grignola

Domingo

2017

BioMed Research International

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The role of the left ventricle in ICU patients with circulatory shock has long been considered. However, acute right ventricle (RV) dysfunction causes and aggravates many common critical diseases (acute respiratory distress syndrome, pulmonary embolism, acute myocardial infarction, and postoperative cardiac surgery). Several supportive therapies, including mechanical ventilation and fluid management, can make RV dysfunction worse, potentially exacerbating shock. We briefly review the epidemiology, pathophysiology, diagnosis, and recommendations to guide management of acute RV dysfunction in ICU patients. Our aim is to clarify the complex effects of mechanical ventilation, fluid therapy, vasoactive drug infusions, and other therapies to resuscitate the critical patient optimally.

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“…The weaning rate from the right VAD was possible in the 45-75% of the patients (51). The major complication was represented bleeding and thrombosis of the VAD (52). They include the LVAD (Jarvik and HeartWare devices) (53) used in right position and the CentriMag paracorporeal VAD (54,55).…”

Section: Temporary Right Ventricular Supportmentioning

confidence: 99%

Right ventricular failure after left ventricular assist device implantation: a review of the literature

Coco¹,

Piero²,

Massimi³

et al. 2021

J Thorac Dis

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Right ventricular failure (RVF) following left ventricular assist device (LVAD) implantation remains a major complication which may significantly impair patient outcome. The genesis of RVF is, however, multifactorial, and the mechanisms underlying such a condition have not been fully elucidated, making its prevention challenging and the course not always predictable. Although preoperative risks factors can be associated with RV impairment, the physiologic changes after the LV support, can still hamper the function of the RV. Current medical treatment options are limited and sometimes, patients with a severe post-LVAD RVF may be unresponsive to pharmacological therapy and require more aggressive treatment, such as temporary RV support. We retrieved 11 publications which we assessed and divided in groups based on the RV support [extracorporeal membrane oxygenation (ECMO), right ventricular assist device (RVAD), TandemHeart with ProtekDuo cannula]. The current review comprehensively summarizes the main studies of the literature with particular attention to the RV physiology and its changes after the LVAD implantation, the predictors and prognostic score as well as the different modalities of temporary mechanical cardiocirculatory support, and its effects on patient prognosis for RVF in such a setting. In addition, it provides a decision making of the pre-, intra and post-operative management in high-and moderate-risk patients.

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Recurrent Clotting of a Continuous-Flow Right Ventricular Assist Device—Repeated Thrombolysis With Two Different Protocols

Cited by 5 publications

References 22 publications

Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology

Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology

Acute Right Ventricular Dysfunction in Intensive Care Unit

Right ventricular failure after left ventricular assist device implantation: a review of the literature

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