OBJECTIVES: This study sought to develop a model that estimates the post-operative risk of right ventricular (RV) failure in left ventricular assist device (LVAD) candidates. BACKGROUND: Right ventricular failure after LVAD surgery is associated with increased morbidity and mortality, but identifying LVAD candidates at risk for RV failure remains difficult. METHODS: A prospectively collected LVAD database was evaluated for pre-operative clinical, laboratory, echocardiographic, and hemodynamic predictors of RV failure. Right ventricular failure was defined as the need for post-operative intravenous inotrope support for >14 days, inhaled nitric oxide for > or =48 h, right-sided circulatory support, or hospital discharge on an inotrope. An RV failure risk score (RVFRS) was created from multivariable logistic regression model coefficients, and a receiver-operating characteristic curve of the score was generated. RESULTS: Of 197 LVADs implanted, 68 (35%) were complicated by post-operative RV failure. A vasopressor requirement (4 points), aspartate aminotransferase > or =80 IU/l (2 points), bilirubin > or =2.0 mg/dl (2.5 points), and creatinine > or =2.3 mg/dl (3 points) were independent predictors of RV failure. The odds ratio for RV failure for patients with an RVFRS < or =3.0, 4.0 to 5.0, and > or =5.5 were 0.49 (95% confidence interval [CI] 0.37 to 0.64), 2.8 (95% CI 1.4 to 5.9), and 7.6 (95% CI 3.4 to 17.1), respectively, and 180-day survivals were 90 +/- 3%, 80 +/- 8%, and 66 +/- 9%, respectively (log rank for linear trend p = 0.0045). The area under the receiver-operating characteristic curve for the RVFRS (0.73 +/- 0.04) was superior to that of other commonly used predictors of RV failure (all p < 0.05). CONCLUSIONS: The RVFRS, composed of routinely collected, noninvasive pre-operative clinical data, effectively stratifies the risk of RV failure and death after LVAD implantation.
OBJECTIVES: This study sought to develop a model that estimates the post-operative risk of right ventricular (RV) failure in left ventricular assist device (LVAD) candidates. BACKGROUND:Right ventricular failure after LVAD surgery is associated with increased morbidity and mortality, but identifying LVAD candidates at risk for RV failure remains difficult. METHODS: A prospectively collected LVAD database was evaluated for pre-operative clinical, laboratory, echocardiographic, and hemodynamic predictors of RV failure. Right ventricular failure was defined as the need for post-operative intravenous inotrope support for >14 days, inhaled nitric oxide for > or =48 h, right-sided circulatory support, or hospital discharge on an inotrope. An RV failure risk score (RVFRS) was created from multivariable logistic regression model coefficients, and a receiver-operating characteristic curve of the score was generated. RESULTS: Of 197 LVADs implanted, 68 (35%) were complicated by post-operative RV failure. A vasopressor requirement (4 points), aspartate aminotransferase > or =80 IU/l (2 points), bilirubin > or =2.0 mg/dl (2.5 points), and creatinine > or =2.3 mg/dl (3 points) were independent predictors of RV failure. The odds ratio for RV failure for patients with an RVFRS < or =3.0, 4.0 to 5.0, and > or =5.5 were 0.49 (95% confidence interval [CI] 0.37 to 0.64), 2.8 (95% CI 1.4 to 5.9), and 7.6 (95% CI 3.4 to 17.1), respectively, and 180-day survivals were 90 +/- 3%, 80 +/- 8%, and 66 +/- 9%, respectively (log rank for linear trend p = 0.0045). The area under the receiver-operating characteristic curve for the RVFRS (0.73 +/- 0.04) was superior to that of other commonly used predictors of RV failure (all p < 0.05). CONCLUSIONS: The RVFRS, composed of routinely collected, noninvasive pre-operative clinical data, effectively stratifies the risk of RV failure and death after LVAD implantation.
Authors: Nicholas C Dang; Veli K Topkara; Michelle Mercando; Joy Kay; Kurt H Kruger; Michael S Aboodi; Mehmet C Oz; Yoshifumi Naka Journal: J Heart Lung Transplant Date: 2005-12-09 Impact factor: 10.247
Authors: D J Farrar; J D Hill; D G Pennington; L R McBride; W L Holman; R L Kormos; D Esmore; L A Gray; P E Seifert; G P Schoettle; C H Moore; P J Hendry; J N Bhayana Journal: J Thorac Cardiovasc Surg Date: 1997-01 Impact factor: 5.209
Authors: M C Oz; M Argenziano; K A Catanese; M T Gardocki; D J Goldstein; R C Ashton; A C Gelijns; E A Rose; H R Levin Journal: Circulation Date: 1997-04-01 Impact factor: 29.690
Authors: Minoo N Kavarana; Melissa S Pessin-Minsley; Jacqueline Urtecho; Katharine A Catanese; Margaret Flannery; Mehmet C Oz; Yoshifumi Naka Journal: Ann Thorac Surg Date: 2002-03 Impact factor: 4.330
Authors: Yoshie Ochiai; Patrick M McCarthy; Nicholas G Smedira; Michael K Banbury; Jose L Navia; Jingyuan Feng; Amy P Hsu; Michael L Yeager; Tiffany Buda; Katherine J Hoercher; Michael W Howard; Masami Takagaki; Kazuyoshi Doi; Kiyotaka Fukamachi Journal: Circulation Date: 2002-09-24 Impact factor: 29.690
Authors: R L Kormos; T A Gasior; A Kawai; S M Pham; S Murali; B G Hattler; B P Griffith Journal: J Thorac Cardiovasc Surg Date: 1996-04 Impact factor: 5.209
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
Authors: Athanasios Tsiouris; Gaetano Paone; Hassan W Nemeh; Jamil Borgi; Celeste T Williams; David E Lanfear; Jeffrey A Morgan Journal: World J Cardiol Date: 2015-11-26
Authors: Antolin S Flores; Michael Essandoh; Gregory C Yerington; Amar M Bhatt; Manoj H Iyer; William Perez; Victor R Davila; Ravi S Tripathi; Katja Turner; Galina Dimitrova; Michael J Andritsos Journal: J Thorac Dis Date: 2015-12 Impact factor: 2.895