When Nothing Goes Right: Risk Factors and Biomarkers of Right Heart Failure after Left Ventricular Assist Device Implantation

Schlöglhofer, Thomas; Wittmann, Franziska; Paus, Robert; Riebandt, Julia; Schaefer, Anne‐Kristin; Angleitner, Philipp; Granegger, Marcus; Aigner, Philipp; Wiedemann, Dominik; Laufer, Günther; Schima, Heinrich; Zimpfer, Daniel

doi:10.3390/life12030459

Cited by 6 publications

(11 citation statements)

References 28 publications

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“…Moreover, the risk of readmission due to severe adverse events increases as patients stay longer in LVAD support [9]. Some recurrent adverse events with rates noted at 1 year post-implant are shown in Figure 2 [9][10][11][12].…”

Section: Clinical Complications Of Aortic Insufficiency During Lvad S...mentioning

confidence: 99%

Aortic Insufficiency in LVAD Patients

Vu¹,

May‐Newman²

2023

Ventricular Assist Devices - Advances and Applications in Heart Failure

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Aortic insufficiency (AI) is a common complication that increases morbidity and mortality in patients with left ventricular assist devices (LVAD). Significant AI during LVAD support creates a substantial regurgitant flow loop, negatively affecting cardiac recovery and exposing blood to longer residence time and higher shear stress. The mechanism of AI development and progression is linked to a lack of aortic valve opening, which alters the valvular tissue mechanics. Pre-existing AI also worsens following LVAD implantation, interfering with the pump benefits. This chapter will evaluate AI development with LVAD support compared with naturally occurring AI and present the features, mechanisms, and links to clinical treatment options.

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Section: Clinical Complications Of Aortic Insufficiency During Lvad S...mentioning

confidence: 99%

Aortic Insufficiency in LVAD Patients

Vu¹,

May‐Newman²

2023

Ventricular Assist Devices - Advances and Applications in Heart Failure

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“…Široj medicinskoj javnosti dostupni su različiti faktori rizika i skorovi rizika, ali nisu opšteprihvaćeni, pa je identifikacija bolesnika sa povišenim rizikom za SDK i dalje predmet debate (20). Dokazano je da kod velikog broja bolesnika sa blagom do umerenom preimplantacionom SDK dolazi do stabilizacije funkcionisanja DK nakon LVAD implantacije (21).…”

Section: Uvodunclassified

“…U mnogim kardiohirurškim centrima praktikuje se i alternativni način ugradnje Terzić D. et al Značaj funkcije desne srčane komore za ishod lečenja i remodelovanje srca nakon implantacije uređaja za trajnu mehaničku cirkulatornu potporu leve komore. MedPodml 2022, 73(4): [21][22][23][24][25][26][27] LVAD kroz lateralnu torakotomiju, gde se prezervira perikard, čime se održava geometrija DK (22). Ovde treba naglasiti da su opcije biventrikularne cirkulatorne podrške i ugradnje totalnog artificijelnog srca potencijalno rešenje kod bolesnika sa izrazito oštećenom funkcijom DK, ali ove metode imaju lošije kratkoročne i dugoročne rezultate u poređenju sa izolovanom LVAD implantacijom ili transplantacijom srca, pre svega usled znatno veće incidencije neželjenih odgađaja i lošijeg postoperativnog kvaliteta života (23).…”

Section: Uvodunclassified

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Significance of right ventricular function for the outcome of treatment and remodeling of the heart after left ventricular assist device implantation

Terzić¹,

Mikić²

2022

Medicinski podmladak

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The efficiency of the device for permanent circulatory support of the left ventricle has been proven through clinical practice with the trend of constant improvement of treatment results along with biotechnological progress and improvement of surgical implantation techniques. The published reports of most reference cardiac surgery centers present a one-year survival rate of over 85%, a two-year survival rate of 70% and a five-year survival rate of 45-50%. In addition to clear benefits for the patient, implantation of LVAD also carries significant specific risks, so infections, post-implantation bleeding, strokes, and right ventricular postimplantation weakness are the most common complications. Given that the progress of the LVAD program is ensured primarily by reducing the incidence of complications not related to the functioning of individual segments of the cardiovascular system, and as left ventricular function is completely replaced by LVAD device, the most recent challenge is the decision to install LVAD device in the heart with right ventricular, given that the postimplantation weakness of right ventricular is associated with proven increased mortality and morbidity. Since the 1990s, studies on hearts with implanted LVAD as a bridge to heart transplantation have shown regression of cell hypertrophy, normalization of cell size, muscle fiber architecture, and heart chamber geometry. The described changes are characterized by the notion of reverse remodeling, which is synonymous with function recovery. It is this process at the level of the right ventricle that is recognized as extremely important for the success of LVAD programs, especially in the group of patients who have a certain degree of right ventricular weakness preoperatively. The basic requirements of the cardiac surgery team are adequate preoperative assessment of right ventricular weakness, then application of measures to prevent damage and load on the right ventricle during and after LVAD implantation, as well as providing adequate therapeutic measures for right ventricular recovery in the postimplantation period.

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“…number of covariates in the JM is related to sample size. Increasing patient numbers would allow for additional clinically relevant parameters, such as early post-operative heart rate or the diurnal pattern of sST2 (30)(31). …”

mentioning

confidence: 99%

Soluble suppression of tumorigenicity-2 (sST2) predicts mortality and right heart failure in LVAD patients

Numan

Aarts

Ramjankhan³

et al. 2023

Preprint

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Background: Soluble suppression of tumorigenicity-2 (sST2) predicts mortality in heart failure patients. The predictive value of sST2 in left ventricular assist device (LVAD) patients remains unknown. Therefore, we studied the relationship between sST2 and outcome after LVAD implantation. Methods: Patients implanted between January 2015 and December 2022 were included. Survival of patients with normal and elevated pre-operative sST2 levels was compared using Kaplan-Meier analysis. The relationship between post-operative sST2, survival and right heart failure (RHF) was evaluated using a Joint Model (JM). Multivariate JM analysis adjusted for serially measured NT-proBNP was performed. Results: The median follow-up was 25 months, during which 1573 post-operative sST2 levels were measured in 199 patients, with a median of 29 ng/ml. Survival in patients with normal or elevated pre-operative sST2 levels (n=86) did not differ significantly (p=0.22). Time-dependent post-operative sST2 levels were significantly associated with mortality, with a hazard ratio (HR) of 1.20 (95% CI: 1.10-1.30, p<0.01) and a HR of 1.22 (95% CI: 1.07-1.39, p=0.01) for RHF, both per 10 unit sST2 increase. The sST2 instantaneous change was not predictive for survival or RHF (p=0.99, p=0.94 respectively). Multivariate JM analysis showed a significant relationship between sST2 with mortality adjusted for NT-proBNP with HR 1.19 (95% CI: 1.00-1.42, p=0.05), while the HR of RHF was not significant (1.22, 95% CI: 0.94-1.59, p=0.14), both per 10 unit sST2 increase. Conclusion: Time-dependent post-operative sST2 predicts all-cause mortality after LVAD implantation independently of NT-proBNP. Future research is warranted into possible target interventions and the optimal monitoring frequency.

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When Nothing Goes Right: Risk Factors and Biomarkers of Right Heart Failure after Left Ventricular Assist Device Implantation

Cited by 6 publications

References 28 publications

Aortic Insufficiency in LVAD Patients

Aortic Insufficiency in LVAD Patients

Significance of right ventricular function for the outcome of treatment and remodeling of the heart after left ventricular assist device implantation

Soluble suppression of tumorigenicity-2 (sST2) predicts mortality and right heart failure in LVAD patients

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