BACKGROUND: Implantable left ventricular assist device (LVAD) insertion complicated by early right ventricular (RV) failure has a poor prognosis and is generally unpredictable. METHODS: To determine preoperative risk factors for perioperative RV failure after LVAD insertion, patient characteristics and preoperative hemodynamics were analyzed in 100 patients with the HeartMate LVAD (Thermo Cardiosystems, Inc, Woburn, MA) at the Cleveland Clinic. RESULTS: RV assist device support was required for 11 patients (RVAD group). RVAD use was significantly higher in younger patients, female patients, smaller patients, and myocarditis patients. There was no significant difference in the cardiac index, RV ejection fraction, or right atrial pressure between the two groups preoperatively. The preoperative mean pulmonary arterial pressure (PAP) and RV stroke work index (RV SWI) were significantly lower in the RVAD group (p = 0.015 and p = 0.011, respectively). Survival to transplant was poor in the RVAD group (27%) and was 83% in the no-RVAD group. CONCLUSIONS: The need for perioperative RVAD support was low, only 11%. Preoperative low PAP and low RV SWI were significant risk factors for RVAD use.
BACKGROUND: Implantable left ventricular assist device (LVAD) insertion complicated by early right ventricular (RV) failure has a poor prognosis and is generally unpredictable. METHODS: To determine preoperative risk factors for perioperative RV failure after LVAD insertion, patient characteristics and preoperative hemodynamics were analyzed in 100 patients with the HeartMate LVAD (Thermo Cardiosystems, Inc, Woburn, MA) at the Cleveland Clinic. RESULTS: RV assist device support was required for 11 patients (RVAD group). RVAD use was significantly higher in younger patients, female patients, smaller patients, and myocarditispatients. There was no significant difference in the cardiac index, RV ejection fraction, or right atrial pressure between the two groups preoperatively. The preoperative mean pulmonary arterial pressure (PAP) and RV stroke work index (RV SWI) were significantly lower in the RVAD group (p = 0.015 and p = 0.011, respectively). Survival to transplant was poor in the RVAD group (27%) and was 83% in the no-RVAD group. CONCLUSIONS: The need for perioperative RVAD support was low, only 11%. Preoperative low PAP and low RV SWI were significant risk factors for RVAD use.
Authors: Yajuan Wang; Marc A Simon; Pramod Bonde; Bronwyn U Harris; Jeffrey J Teuteberg; Robert L Kormos; James F Antaki Journal: J Heart Lung Transplant Date: 2011-12-14 Impact factor: 10.247
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Authors: Kiyotaka Fukamachi; David J Horvath; Alex L Massiello; Yoshio Ootaki; Keiji Kamohara; Masatoshi Akiyama; Firas Zahr; Michael W Kopcak; Raymond Dessoffy; Ji-Feng Chen; Stephen Benefit; Leonard A R Golding Journal: ASAIO J Date: 2005 Nov-Dec Impact factor: 2.872
Authors: Pavan Atluri; Andrew B Goldstone; Alex S Fairman; John W MacArthur; Yasuhiro Shudo; Jeffrey E Cohen; Alexandra L Acker; William Hiesinger; Jessica L Howard; Michael A Acker; Y Joseph Woo Journal: Ann Thorac Surg Date: 2013-06-21 Impact factor: 4.330
Authors: J Raymond Fitzpatrick; John R Frederick; Vivian M Hsu; Elliott D Kozin; Mary Lou O'Hara; Elan Howell; Deborah Dougherty; Ryan C McCormick; Carine A Laporte; Jeffrey E Cohen; Kevin W Southerland; Jessica L Howard; Mariell L Jessup; Rohinton J Morris; Michael A Acker; Y Joseph Woo Journal: J Heart Lung Transplant Date: 2008-12 Impact factor: 10.247