Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: Incidence, risk factors, and effect on outcomes

Kormos, Robert L.; Teuteberg, Jeffrey J.; Pagani, Francis D.; Russell, Stuart D.; John, Ranjit; Miller, Leslie W.; Massey, Todd; Milano, Carmelo A.; Moazami, Nader; Sundareswaran, Kartik S.; Farrar, David J.

doi:10.1016/j.jtcvs.2009.11.020

Cited by 821 publications

(648 citation statements)

References 21 publications

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“…Multiple mechanisms contribute but delayed incidence of VAs is mostly secondary to pre‐existing substrate combined with a lack of favorable remodeling from the LVADs 23, 24. Sustained VAs are well tolerated by the LVAD‐supported LV, but prolonged duration of VAs can result in right ventricular dysfunction and right heart failure, which can contribute to worse outcomes in LVAD patients 25, 26. Therefore, it is common practice to continue ICD therapies following CF‐LVAD implantation and is supported by the 2013 mechanical circulatory support guidelines from the International Society of Heart and Lung Transplant 8.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Resynchronization Therapy and Clinical Outcomes in Continuous Flow Left Ventricular Assist Device Recipients

Gopinathannair

Roukoz

Bhan

et al. 2018

JAHA

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BackgroundMany patients with heart failure continue cardiac resynchronization therapy (CRT) after continuous flow left ventricular assist device (CF‐LVAD) implant. We report the first multicenter study to assess the impact of CRT on clinical outcomes in CF‐LVAD patients.Methods and ResultsAnalysis was performed on 488 patients (58±13 years, 81% male) with an implantable cardioverter defibrillator (ICD) (n=223) or CRT‐D (n=265) who underwent CF‐LVAD implantation at 5 centers from 2007 to 2015. Effects of CRT on mortality, hospitalizations, and ventricular arrhythmia incidence were compared against CF‐LVAD patients with an ICD alone. Baseline differences were noted between the 2 groups in age (60±12 versus 55±14, P<0.001) and QRS duration (159±29 versus 126±34, P=0.001). Median biventricular pacing in the CRT group was 96%. During a median follow‐up of 478 days, Kaplan–Meier analysis showed no difference in survival between groups (log rank P=0.28). Multivariate Cox regression demonstrated no survival benefit with type of device (ICD versus CRT‐D; P=0.16), whereas use of amiodarone was associated with increased mortality (hazard ratio 1.77, 95% confidence interval 1.1–2.8, P=0.01). No differences were noted between CRT and ICD groups in all‐cause (P=0.06) and heart failure (P=0.9) hospitalizations, ventricular arrhythmia incidence (43% versus 39%, P=0.3), or ICD shocks (35% versus 29%, P=0.2). During follow‐up, 69 (26%) patients underwent pulse generator replacement in the CRT‐D group compared with 36 (15.5%) in the ICD group (P=0.003).ConclusionsIn this large, multicenter CF‐LVAD cohort, continued CRT was not associated with improved survival, hospitalizations, incidence of ventricular arrhythmia and ICD therapies, and was related to a significantly higher number of pulse generator changes.

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Section: Discussionmentioning

confidence: 99%

Cardiac Resynchronization Therapy and Clinical Outcomes in Continuous Flow Left Ventricular Assist Device Recipients

Gopinathannair

Roukoz

Bhan

et al. 2018

JAHA

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“…For instance, pulmonary hypertension is a significant contraindication for transplantation but not for LVAD therapy (22). In contrast, patients with severe right ventricular failure are less optimal candidates for LVAD, but may experience good outcomes with transplantation (23)(24)(25)(26). With regards to renal dysfunction, current data show that LVAD implantation can lead to an improvement (27).…”

Section: Discussionmentioning

confidence: 99%

Heart transplantation versus left ventricular assist devices as destination therapy or bridge to transplantation for 1-year mortality: a systematic review and meta-analysis

Theochari¹,

Michalopoulos²,

Oikonomou³

et al. 2018

Ann. Cardiothorac. Surg.

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Background: The optimal treatment for advanced heart failure (HF) patients with regards to mortality remains unknown. Heart transplantation (HTx) and left ventricular assist devices (LVAD) used either as a bridge to transplant (BTT) or destination therapy (DT) have been compared in a number of studies, without definite conclusions with regards to mortality benefit. We sought to systematically review the pertinent literature and perform a meta-analysis of all the available studies presenting head-to-head comparisons between HTx and LVAD BTT or LVAD DT for late (>6 months) all-cause mortality.Methods: We performed a systematic search of Medline and Cochrane Central databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted a meta-analysis of late mortality comparing HTx vs. BTT LVAD and HTx vs. DT LVAD using a random effects model.Results: Eight studies were included in our meta-analysis, reporting data on 7,957 patients in total.Although the available studies are of high quality [8 stars in Newcastle-Ottawa Scale (NOS) on average], there is paucity of mortality data. Specifically, seven studies compared HTx with BTT and five studies compared HTx with DT for 1-year mortality. Our pooled estimates showed that there was no difference in late mortality among these strategies. Conclusions:Our meta-analysis highlights the small number and the heterogeneity of available studies referring to the optimal invasive management of advanced HF, and shows that there are no differences between HTx and LVAD for these patients with regards to late mortality.

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“…8 Recent INTERMACS registry data demonstrate that both higher right atrial pressures and the need for biventricular assistance are associated with death in patients receiving LVADs. 4 Careful pre-operative selection along with timely right-sided MCS and medical therapy may be beneficial in addressing right-sided heart failure.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, the presence of right sided heart failure prior to LVAD implant is associated with a longer hospital LOS versus those without right sided heart failure. 8 Previous studies have not fully described hospital LOS after LVAD implantation and risk factors that may contribute to longer hospital LOS. Understanding hospital LOS and factors that contribute to LOS may provide important information with which to inform patients who are considering LVAD implantation, assist clinicians with patient selection, develop strategies to reduce hospital LOS, and ultimately reduce resource utilization.…”

mentioning

confidence: 99%

42 Predictors of Hospital Length of Stay Following Implantation of a Left Ventricular Assist Device: An Analysis of the INTERMACS Registry

Cotts

Grady

Naftel

et al. 2012

The Journal of Heart and Lung Transplantation

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Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: Incidence, risk factors, and effect on outcomes

Cited by 821 publications

References 21 publications

Cardiac Resynchronization Therapy and Clinical Outcomes in Continuous Flow Left Ventricular Assist Device Recipients

Cardiac Resynchronization Therapy and Clinical Outcomes in Continuous Flow Left Ventricular Assist Device Recipients

Heart transplantation versus left ventricular assist devices as destination therapy or bridge to transplantation for 1-year mortality: a systematic review and meta-analysis

42 Predictors of Hospital Length of Stay Following Implantation of a Left Ventricular Assist Device: An Analysis of the INTERMACS Registry

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