The incidence, risk factors, and outcomes associated with late right-sided heart failure in patients supported with an axial-flow left ventricular assist device

Rich, Jonathan D.; Gošev, Igor; Patel, Chetan B.; Joseph, Susan; Katz, Jason N.; Eckman, Peter; Lee, Sang-Jin; Sundareswaran, Kartik S.; Kilic, Ahmet; Bethea, Brian; Soleimani, Behzad; Lima, Brian; Uriel, Nir; Kiernan, Michael S.

doi:10.1016/j.healun.2016.08.010

Cited by 111 publications

(76 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Current state-of-theart devices are promising in terms of improved survival and lower morbidity rates [4]. However, early post-LVAD mortality remains high [5][6][7][8]. Furthermore, causes and determinants of death following LVAD implantation are not well described for the European population.…”

Section: Introductionmentioning

confidence: 99%

Causes and predictors of early mortality in patients treated with left ventricular assist device implantation in the European Registry of Mechanical Circulatory Support (EUROMACS)

Akın

Soliman

et al. 2020

Intensive Care Med

View full text Add to dashboard Cite

The aim of the study was to analyze early mortality after continuous-flow left ventricular assist device (LVAD) implantation which remains high. Methods: We analyzed consecutive (n = 2689) patients from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) undergoing continuous-flow LVAD implantation. The primary outcome was early (< 90 days) mortality. Secondary outcomes were differential causes of early post-operative death following LVAD implantation. Results: Univariable and multivariable analysis as well as regression analysis were used to examine determinants and differential causes of early (< 90 days) mortality after LVAD implantation. During the first 90 days, 2160 (80%) patients were alive with ongoing LVAD support, 40(2%) patients underwent heart transplantation, and 487(18%) deceased. The main causes of early death were MOF (36%), sepsis (28%), cardiopulmonary failure (CPF; 10%), CVA (9%), and rightsided heart failure (RHF, 8%). Furthermore, MOF and sepsis are 70% of causes of death in the first week. Independent clinical predictors of early death were age, female sex, INTERMACS profile 1 to 3, and ECMO. Laboratory predictors included elevated serum creatinine, total bilirubin, lactate, and low hemoglobin. Furthermore, hemodynamic predictors included elevated RA-to-PCWP ratio, pulmonary vascular resistance, and low systemic vascular resistance. Longer total implantation time was also independent predictor of early mortality. A simple model of 12 variables predicts early mortality following LVAD implantation with a good discriminative power with area under the curve of 0.75. Conclusions: In the EUROMACS registry, approximately one out of five patients die within 90 days after LVAD implantation. Early mortality is primarily dominated by multiorgan failure followed by sepsis. A simple model identifies important parameters which are associated with early mortality following LVAD implantation.

show abstract

Section: Introductionmentioning

confidence: 99%

Causes and predictors of early mortality in patients treated with left ventricular assist device implantation in the European Registry of Mechanical Circulatory Support (EUROMACS)

Akın

Soliman

et al. 2020

Intensive Care Med

View full text Add to dashboard Cite

show abstract

“…Although some of the studied patients on inotropes at the time of listing may have been on inotropes since the time of implantation, several of these patients on inotropes at the time of transplantation developed worsening RV failure after successful LVAD implantation. Late onset of RV failure occurs in approximately 10% of patients after successful LVAD implantation 10 and portends worse outcomes. Our study results confirm that late RV failure is not infrequent and is associated with worse wait‐list mortality and transplantation rates compared with other LVAD patients with indications for status IA listing.…”

Section: Discussionmentioning

confidence: 99%

Temporal trends and outcomes of patients waiting on left ventricular assist devices and inotropes for heart transplantation

Briasoulis

Adegbala

Akintoye

et al. 2020

Clinical Transplantation

View full text Add to dashboard Cite

We sought to evaluate the trends and outcomes of patients with left ventricular assist devices (LVADs) and inotropes at the time of listing for heart transplantation. Adults with an LVAD implanted and listed with 1A status were identified in the United Network for Organ Sharing (UNOS) registry between 2010 and 2017. Patients were grouped according to the presence or absence of inotropes at the time of listing and transplantation. A total of 2714 patients were included in the study including 664 patients on inotropes at the time of listing, 235 at the time of transplantation, and 118 on inotropes both at listing and at the time of transplantation. Patients on LVAD and inotropes at the time of listing were more frequently supported with a right ventricular assist device (RVAD) (P < .001), had higher risk of death in the waiting list (sub‐hazard ratio [SHR] = 1.48, 95% CI 1.14‐1.90, P = .002), and were less likely to be transplanted (SHR = 0.70, 95% CI 0.63‐0.78, P < .001) compared with those not on inotropes, after adjusting for described confounders. Approximately 1 in 10 LVAD recipients listed as status 1A are on inotropic therapy at the time of heart transplantation. Patients on LVAD and inotropes have worse outcomes in terms of survival and lower rates of transplantation.

show abstract

“…While RVF and right ventricular assist device (RVAD) use in LVAD patients have declined with better patient selectivity and utilization of intra-operative maneuvers (53) to reduce the strain on the right ventricle, RVF remains a serious complication associated with decreased survival (54). Univariate predictors of RVF such as DT intent of therapy, INTERMACS profile, preoperative hemodynamic profile, and baseline lab values have been proposed (55)(56)(57), and while a number of risk scores have been developed to predict RVF (55,(58)(59)(60), appropriate selection and prediction of the RV prior to LVAD implementation remains imperfect (41).…”

Section: Rvf and Tah Developmentsmentioning

confidence: 99%

Advancements in mechanical circulatory support for patients in acute and chronic heart failure

Csepe

Kilic

2017

J. Thorac. Dis.

Self Cite

View full text Add to dashboard Cite

Cardiogenic shock (CS) continues to have high mortality and morbidity despite advances in pharmacological, mechanical, and reperfusion approaches to treatment. When CS is refractory to medical therapy, percutaneous mechanical circulatory support (MCS) should be considered. Acute MCS devices, ranging from intra-aortic balloon pumps (IABPs) to percutaneous temporary ventricular assist devices (VAD) to extracorporeal membrane oxygenation (ECMO), can aid, restore, or maintain appropriate tissue perfusion before the development of irreversible end-organ damage. Technology has improved patient survival to recovery from CS, but in patients whom cardiac recovery does not occur, acute MCS can be effectively utilized as a bridge to long-term MCS devices and/or heart transplantation. Heart transplantation has been limited by donor heart availability, leading to a greater role of left ventricular assist device (LVAD) support. In patients with biventricular failure that are ineligible for LVAD implantation, further advancements in the total artificial heart (TAH) may allow for improved survival compared to medical therapy alone. In this review, we discuss the current state of acute and durable MCS, ongoing advances in LVADs and TAH devices, improved methods of durable MCS implantation and patient selection, and future MCS developments in this dynamic field that may allow for optimization of HF treatment.

show abstract

The incidence, risk factors, and outcomes associated with late right-sided heart failure in patients supported with an axial-flow left ventricular assist device

Abstract: LRHF is an important complication in patients with LVADs and is associated with worse quality of life, reduced functional capacity, more frequent hospitalizations, and worse survival compared with those without LRHF.

Cited by 111 publications

References 31 publications

Causes and predictors of early mortality in patients treated with left ventricular assist device implantation in the European Registry of Mechanical Circulatory Support (EUROMACS)

Causes and predictors of early mortality in patients treated with left ventricular assist device implantation in the European Registry of Mechanical Circulatory Support (EUROMACS)

Temporal trends and outcomes of patients waiting on left ventricular assist devices and inotropes for heart transplantation

Advancements in mechanical circulatory support for patients in acute and chronic heart failure

Contact Info

Product

Resources

About