Successful management of right ventricular failure with the ventricular assist pump following aortic valve replacement and coronary bypass grafting

O’Neill, Martin J.; Pierce, William S.; Wisman, Craig B.; Osbakken, Mary D.; Parr, Grant V.S.; Waldhausen, John A.

doi:10.1016/s0022-5223(19)37449-5

Cited by 31 publications

(3 citation statements)

References 11 publications

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“…Right ventricular (RV) failure has been reported to be a major complication associated with the clinical use of LVADs. A review of the literature on clinical LVAD experience [1][2][3][4][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] along With our own results reveals that of 213 patients who received LVADs at 12 centers (not including patients with RVAD and IABP), 20 required the additional use of an RVAD for RV dysfunction and 29 died as a direct result of RV failure (Table 1). Thus, 49 patients (23%) treated with an LVAD for LV failure were candidates for biventricular support.…”

Section: Clinical Incidence Of Right Heart Failure During Left Heart ...mentioning

confidence: 99%

“…Although RV failure during left heart assist is a serious problem, there is apparently a large degree of variability in its frequency at different centers (Table 1). Pierce and associates [1,2,17,24,27,29,30], using the Pierce-Donachy VAD, have reported severe RV failure in 6 LVAD patients, 5 of whom were assisted additionally by an RVAD. Using the Medtronics centrifugal pump and later the Pierce-Donachy VAD manufactured by Thoratec, Pennington et al [4] reported left ventricular support in 24 patients.…”

Section: Clinical Incidence Of Right Heart Failure During Left Heart ...mentioning

confidence: 99%

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Right heart interaction with the mechanically assisted left heart

et al. 1985

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Right ventricular (RV) failure has been reported to be a problem in 49 of 213 patients who received left ventricular assist devices (LVAD) at 12 different centers. Although the pathology of the problem is not understood, it is clear that the effect of an LVAD on hemodynamic ventricular interactions due to the right and left hearts being in series, and on mechanical ventricular interactions due to the anatomic coupling between the ventricles, could play a role in determining the ultimate fate of the right ventricle. Six hypotheses were generated concerning beneficial and detrimental effects of an LVAD on the determinants of right ventricular function (preload, afterload, contractility). The major potential effect on RV preload is increased venous return produced by the LVAD which can overload a marginal RV; but beneficial effects on RV preload and filling also can be produced by the LVAD unloading a dilated LV, thereby shifting the interventricular septum, which had encroached into the RV, back to the left. A significant beneficial effect on RV afterload can be produced with an LVAD by passive reductions in pulmonary artery (PA) pressure secondary to reductions in left atrial pressure; with pulmonary obstructive disease, however, PA pressures can increase due to the greater blood flow through the fixed pulmonary vascular resistance. The major effects on RV contractility produced by an LVAD are significantly beneficial since aortic and, therefore, coronary perfusion pressure is maintained. There also is a potential detrimental effect on RV contractility produced by decreased septal contribution to RV contraction during complete LV unloading with an LVAD. The initial therapy for the failing right ventricle in patients with an LVAD is volume loading. Isoproterenol, dobutamine, and dopamine can be used for inotropic support, and atrial pacing can improve the atrial contribution to filling. If these modalities fail, surgical techniques including pulmonary artery balloon pump or extracorporeal membrane oxygenation can be tried, but the recommended mechanical support is a right ventricular assist device.

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Section: Clinical Incidence Of Right Heart Failure During Left Heart ...mentioning

confidence: 99%

Section: Clinical Incidence Of Right Heart Failure During Left Heart ...mentioning

confidence: 99%

Right heart interaction with the mechanically assisted left heart

et al. 1985

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“…In addition, previous models hardly reproduce the natural history of HF, with limitations and interests for specific areas. Although rare, isolated right ventricular (RV) failure can complicate an acute myocardial infarction (3)(4)(5)(6) or a coronary artery bypass grafting surgery, as a consequence of inadequate myocardial protection (7,8). At present, the ideal clinical and/or surgical treatment of RV failure is not very well established.…”

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confidence: 99%

Assessment of a New Experimental Model of Isolated Right Ventricular Failure

Thomaz¹,

Assad²,

Abduch³

et al. 2009

Artificial Organs

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We assessed a new experimental model of isolated right ventricular (RV) failure, achieved by means of intramyocardial injection of ethanol. RV dysfunction was induced in 13 mongrel dogs via multiple injections of 96% ethanol (total dose 1 mL/kg), all over the inlet and trabecular RV free walls. Hemodynamic and metabolic parameters were evaluated at baseline, after ethanol injection, and on the 14th postoperative day (POD). Echocardiographic parameters were evaluated at baseline, on the sixth POD, and on the 13th POD. The animals were then euthanized for histopathological analysis of the hearts. There was a 15.4% mortality rate. We noticed a decrease in pulmonary blood flow right after RV failure (P = 0.0018), as well as during reoperation on the 14th POD (P = 0.002). The induced RV dysfunction caused an increase in venous lactate levels immediately after ethanol injection and on the 14th POD (P < 0.0003). The echocardiogram revealed a decrease in the RV ejection fraction on the sixth and 13th PODs (P = 0.0001). There was an increased RV end-diastolic volume on the sixth (P = 0.0001) and 13th PODs (P = 0.0084). The right ventricle showed a 74% +/- 0.06% transmural infarction area, with necrotic lesions aged 14 days. Intramyocardial ethanol injection has allowed the creation of a reproducible and inexpensive model of RV failure. The hemodynamic, metabolic, and echocardiographic parameters assessed at different protocol times are compatible with severe RV failure. This model may be useful in understanding the pathophysiology of isolated right-sided heart failure, as well as in the assessment of ventricular assist devices.

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Perioperative Right Heart Dysfunction

Payne¹,

Cleveland²

1988

Developments in Cardiovascular Medicine

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Successful management of right ventricular failure with the ventricular assist pump following aortic valve replacement and coronary bypass grafting

Cited by 31 publications

References 11 publications

Right heart interaction with the mechanically assisted left heart

Right heart interaction with the mechanically assisted left heart

Assessment of a New Experimental Model of Isolated Right Ventricular Failure

Perioperative Right Heart Dysfunction

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