Right ventricular dysfunction and organ failure in left ventricular assist device recipients: a continuing problem

Kavarana, Minoo N.; Pessin, Melissa S.; Urtecho, Jacqueline; Catanese, Katharine A.; Flannery, M.; Öz, Mehmet C.; Naka, Yoshifumi

doi:10.1016/s0003-4975(01)03406-3

Cited by 292 publications

(202 citation statements)

References 15 publications

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“…This increased incidence of right ventricular failure in patients with preoperative PCPS may be attributable in part to lung injury exacerbated by preoperative PCPS, 11 in addition to pre-existing right ventricular dysfunction, which is unmasked with the increase in right-sided preload afforded by LVAD support. 15 This speculation is supported by the fact that more patients with preoperative PCPS required nitric oxide inhalation for reduction of pulmonary vascular resistance in order to be weaned from CPB. Further studies are necessary to clarify to what extent preoperative PCPS itself affects right ventricular function by inducing lung injury.…”

Section: Discussionmentioning

confidence: 99%

Impact of Preoperative Percutaneous Cardiopulmonary Support on Outcome Following Left Ventricular Assist Device Implantation

Toda

Fujita

Kobayashi

et al. 2012

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp echanical circulatory support with a left ventricular assist device (LVAD) has become a well-established procedure for patients with end-stage heart failure. Patient selection and timing of implantation, however, remain critical issues. Although several studies have identified pre-implantation risk factors in regard to mortality, 1,2 most are limited by the fact that few of the reported patients were supported by an LVAD for a prolonged period. Because prolonged LVAD support has become prevalent not only as a bridge to transplantation but also for destination therapy, it is important to find preoperative risk factors for patients supported by an LVAD for a prolonged period. Preoperative cardiogenic shock is recognized as one of the significant risk factors for mortality after LVAD implantation, 2,3 and percutaneous cardiopulmonary support (PCPS), has been utilized for patients in cardiogenic shock to improve and stabilize the preoperative condition of LVAD candidates. 4,5 Although those studies demonstrated that PCPS can effectively act as a bridge to LVAD therapy for patients in cardiogenic shock, the duration of LVAD support in previous studies was relatively short, and the impact of preoperative PCPS on long-term LVAD support is not known. In Japan, because of a severe donor shortage, the average LVAD support period before heart transplantation is >2 years, 6 which provides a unique opportunity to observe LVAD patients for prolonged periods. In the present study we retrospectively reviewed 103 consecutive patients to clarify the impact of preoperative PCPS on long-term survival following implantation of an LVAD. Methods PatientsThis study was conducted as a retrospective analysis of 103 consecutive cardiomyopathy patients who underwent LVAD implantation as a bridge to heart transplantation at National Cerebral and Cardiovascular Center, Osaka, between May Background: The purpose of the present study was to determine the impact of preoperative percutaneous cardiopulmonary support (PCPS) on long-term survival following implantation of a left ventricular assist device (LVAD).

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Section: Discussionmentioning

confidence: 99%

Impact of Preoperative Percutaneous Cardiopulmonary Support on Outcome Following Left Ventricular Assist Device Implantation

Toda

Fujita

Kobayashi

et al. 2012

Circ J

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“…As seen in other series, elective implant and clinical status both determine positive outcome [12]. It is our belief that early referral and elective implant bring a higher benefit to this patient population.…”

Section: Discussionmentioning

confidence: 53%

Left ventricular assist device as bridge to heart transplantation – lessons learned with the MicroMed DeBakey axial blood flow pump

Salzberg¹,

Lachat²,

Zünd³

et al. 2003

European Journal of Cardio-Thoracic Surgery

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Objective: The MicroMed DeBakey left ventricular assist device (LVAD) axial blood flow pump was used as bridge to heart transplantation (HTx) in patients with terminal heart failure. The aim was to evaluate this novel mechanical circulatory support system in regard to overall outcome. Methods: Prospective study in 15 HTx candidates (mean age 40^7 years) with terminal heart failure and maximal medical treatment due to ischemic cardiomyopathy (CMP, n ¼ 5), dilated CMP ðn ¼ 3Þ, restrictive CMP ðn ¼ 2Þ, unclassified CMP ðn ¼ 1Þ, metabolic CMP ðn ¼ 1Þ, valvular CMP ðn ¼ 1Þ and congenital CMP ðn ¼ 2Þ. All patients were implanted with a MicroMed DeBakey LVAD. A rescue procedure was necessary in eight critical patients, while seven underwent elective LVAD implantation. Procedures were performed via median sternotomy, in normotherm femoro-femoral CPB (mean duration 59^1 min). Oral Marcoumar q (INR 2.0-3.0) and Aspirin q (100 mg daily) were started as soon as possible. Patients were discharged into a specialized rehabilitation clinic from which it was possible to release them home after a few weeks. Results: Successful implantation and discharge from ICU (mean stay 10^7 days) was possible in 11 patients. Seven were transplanted (mean support 50.7 days) and one is awaiting HTx (support .310 days) in the comfort of his home (NYHA I). Survival was 100% among the transplanted patients. Of the seven elective implants, five, and of the eight rescue procedures three patients underwent successful HTx. Four patients died early, while three patients died late on pump support due to intracranial hemorrhage (n ¼ 2, 73 and 76 days) and chest infection (n ¼ 1, 124 days). All survivors were discharged from hospital, with significant decrease in NYHA class (mean 3.8-2.4 ðn ¼ 11Þ). Treadmill testing showed increased exercise tolerance, from 35 to 71 W ðn ¼ 4Þ. Plasma BNP values (mean 950-162 ng/l ðn ¼ 4Þ) and pulmonary resistance (mean 316 -194.5 dyne s/cm 5 ðn ¼ 3Þ) decreased significantly during LVAD support. Conclusions: The MicroMed DeBakey LVAD is simple to implant; outpatient treatment is safe and efficient. Patients' condition and pulmonary resistances normalize within 6 weeks, making previously considered inoperable patients amenable for HTx. HTx can be performed in low-risk situation, allowing better donor -recipient matching and improving overall outcome. q

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“…Right heart failure is also associated with high transfusion rate and increased rate of end-organ failure. The number of days in the intensive care unit and the mortality rate are also increased in RHF patients (22). Thromboembolism is an important complication that occurs in 20% of patients receiving a left or right VAD (15).…”

Section: Complications With Vadsmentioning

confidence: 99%

Cardiac Compression Devices: Alternative Technology and Innovative Concept

Daliri

Yadollahi

Jadbabaei

2017

Multidiscip Cardio Annal

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Heart failure is a leading cause of death around the world. Heart transplantation is the only reliable therapy for improving functional capacity, quality of life, life expectancy, and limiting the options for heart failure patients. In fact, a large number of patients with severe heart failure in need of heart transplantation are unable to receive therapy with up to 30% mortality before a heart is donated. In recent decades, cardiac replacement and assisting therapies have presented promising outcomes to treat these end-stage patients as alternative solutions. These devices are capable of providing temporary to permanent, partial or full assistance. Such devices can be divided into two categories based on location and mechanism of augmentation: 1) devices exposed directly to blood including ventricular assistive devices (VADs) and total artificial hearts (TAHs) and 2) devices that augment cardiac output through compression of ventricles or another part of circulatory system with no direct contact to blood such as extra-cardiac compression devices (ECCDs). In recent years, novel ECCDs which compress tissue and muscles to indirectly assist blood pumping have been developed to circumscribe problems associated with blood-contacting devices and the risks involved with piercing arterial and ventricular walls. Not only do ECCDs aim to reduce risks from the patient and surgeon perspective, the complexity of engineering an intra-corporeal extra-cardiac device is also reduced.

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Right ventricular dysfunction and organ failure in left ventricular assist device recipients: a continuing problem

Cited by 292 publications

References 15 publications

Impact of Preoperative Percutaneous Cardiopulmonary Support on Outcome Following Left Ventricular Assist Device Implantation

Impact of Preoperative Percutaneous Cardiopulmonary Support on Outcome Following Left Ventricular Assist Device Implantation

Left ventricular assist device as bridge to heart transplantation – lessons learned with the MicroMed DeBakey axial blood flow pump

Cardiac Compression Devices: Alternative Technology and Innovative Concept

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