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Tang PC, Millar J, Noly PE, Sicim H, Likosky DS, Zhang M, Pagani FD. Preoperative passive venous pressure-driven cardiac function determines left ventricular assist device outcomes. J Thorac Cardiovasc Surg 2024; 168:133-144.e5. [PMID: 37495169 PMCID: PMC10805966 DOI: 10.1016/j.jtcvs.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/22/2023] [Accepted: 07/16/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Right heart output in heart failure can be compensated through increasing systemic venous pressure. We determined whether the magnitude of this "passive cardiac output" can predict LVAD outcomes. METHODS This was a retrospective review of 383 patients who received a continuous-flow LVAD at the University of Michigan between 2012 and 2021. Pre-LVAD cardiac output driven by venous pressure was determined by dividing right atrial pressure by mean pulmonary artery pressure, multiplied by total cardiac output. Normalization to body surface area led to the passive cardiac index (PasCI). The Youden J statistic was used to identify the PasCI threshold, which predicted LVAD death by 2 years. RESULTS Increased preoperative PasCI was associated with reduced survival (hazard ratio [HR], 2.27; P < .01), and increased risk of right ventricular failure (RVF) (HR, 3.46; P = .04). Youden analysis showed that a preoperative PasCI ≥0.5 (n = 226) predicted LVAD death (P = .10). Patients with PasCI ≥0.5 had poorer survival (P = .02), with a trend toward more heart failure readmission days (mean, 45.09 ± 67.64 vs 35.13 ± 45.02 days; P = .084) and increased gastrointestinal bleeding (29.2% vs 20.4%; P = .052). Additionally, of the 97 patients who experienced readmissions for heart failure, those with pre-LVAD implantation PasCI ≥0.5 were more likely to have more than 1 readmission (P = .05). CONCLUSIONS Although right heart output can be augmented by raising venous pressure, this negatively impacts end-organ function and increases heart failure readmission days. Patients with a pre-LVAD PasCI ≥0.5 have worse post-LVAD survival and increased RVF. Using the PasCI metric in isolation or incorporated into a predictive model may improve the management of LVAD candidates with RV dysfunction.
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Affiliation(s)
- Paul C Tang
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Mich; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
| | - Jessica Millar
- Department of Surgery, University of Michigan Ann Arbor, Mich
| | | | - Hüseyin Sicim
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Mich
| | - Donald S Likosky
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Mich
| | - Min Zhang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Mich
| | - Francis D Pagani
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Mich
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Ambulatory advanced heart failure patients: timing of mechanical circulatory support - delaying the inevitable? Curr Opin Cardiol 2021; 36:186-197. [PMID: 33395078 DOI: 10.1097/hco.0000000000000831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Current indications for continuous-flow left ventricular assist device (cfLVAD) implantation is for patients in cardiogenic shock or inotrope-dependent advanced heart failure. Risk stratification of noninotrope dependent ambulatory advanced heart failure patients is a subject of registries designed to help shared-decision making by clinicians and patients regarding the optimal timing of mechanical circulatory support (MCS). RECENT FINDINGS The Registry Evaluation of Vital Information for VADs in Ambulatory Life enrolled ambulatory noninotrope dependent advanced systolic heart failure patients who had 25% annualized risk of death, MCS, or heart transplantation (HT). Freedom from composite clinical outcome at 1-year follow-up was 23.5% for the entire cohort. Seattle Heart Failure Model Score and Natriuretic pepides were predictors with modest discriminatory power. Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile 4 patients had the highest risk (3.7-fold) of death, MCS or HT compared to INTERMACS profile 7. SUMMARY We propose individualized risk stratification for noninotrope dependent ambulatory advanced heart failure patients and include serial changes in end-organ function, nutritional parameters, frailty assessment, echocardiographic and hemodynamic data. The clinical journey of a patient with advanced heart failure should be tracked and discussed at each clinic visit for shared decision-making regarding timing of cfLVAD.
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Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e348-e392. [DOI: 10.1161/cir.0000000000000535] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Life expectancy and quality of life for those born with congenital heart disease (CHD) have greatly improved over the past 3 decades. While representing a great advance for these patients, who have been able to move from childhood to successful adult lives in increasing numbers, this development has resulted in an epidemiological shift and a generation of patients who are at risk of developing chronic multisystem disease in adulthood. Noncardiac complications significantly contribute to the morbidity and mortality of adults with CHD. Reduced survival has been documented in patients with CHD with renal dysfunction, restrictive lung disease, anemia, and cirrhosis. Furthermore, as this population ages, atherosclerotic cardiovascular disease and its risk factors are becoming increasingly prevalent. Disorders of psychosocial and cognitive development are key factors affecting the quality of life of these individuals. It is incumbent on physicians who care for patients with CHD to be mindful of the effects that disease of organs other than the heart may have on the well-being of adults with CHD. Further research is needed to understand how these noncardiac complications may affect the long-term outcome in these patients and what modifiable factors can be targeted for preventive intervention.
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Abstract
The dual blood supply of the liver, originating from the portal vein and the hepatic artery, makes it relatively resistant to minor circulatory disturbances. However, hepatic manifestations of common cardiovascular disorders are frequently encountered in both the inpatient and outpatient setting. Beginning with the macro- and microcirculation of the liver, this article reviews the pathophysiology of hepatic blood flow and gives a detailed appraisal of ischemic hepatitis, congestive hepatopathy, and other less common hepatic conditions that arise when cardiovascular function is impaired.
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Affiliation(s)
- Ilan S Weisberg
- Division of Gastroenterology and Hepatology, Weill Cornell Medical Center, New York Presbyterian Hospital, 1305 York Avenue, 4th Floor, New York, NY 10021, USA
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Gelow JM, Desai AS, Hochberg CP, Glickman JN, Givertz MM, Fang JC. Clinical Predictors of Hepatic Fibrosis in Chronic Advanced Heart Failure. Circ Heart Fail 2010; 3:59-64. [DOI: 10.1161/circheartfailure.109.872556] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jill M. Gelow
- From the Cardiovascular Division (J.M.G., A.S.D., C.P.H., J.N.G., M.M.G., J.C.F.), Brigham and Women’s Hospital, Boston, Mass; Cardiovascular Division (J.M.G.), Oregon Health and Science University, Portland, Ore; Cardiovascular Division (C.P.H.), Beth Israel Deaconess Medical Center, Boston, Mass; and Cardiovascular Division (J.C.F.), University Hospital-Case Medical Center, Cleveland, Ohio
| | - Akshay S. Desai
- From the Cardiovascular Division (J.M.G., A.S.D., C.P.H., J.N.G., M.M.G., J.C.F.), Brigham and Women’s Hospital, Boston, Mass; Cardiovascular Division (J.M.G.), Oregon Health and Science University, Portland, Ore; Cardiovascular Division (C.P.H.), Beth Israel Deaconess Medical Center, Boston, Mass; and Cardiovascular Division (J.C.F.), University Hospital-Case Medical Center, Cleveland, Ohio
| | - Claudia P. Hochberg
- From the Cardiovascular Division (J.M.G., A.S.D., C.P.H., J.N.G., M.M.G., J.C.F.), Brigham and Women’s Hospital, Boston, Mass; Cardiovascular Division (J.M.G.), Oregon Health and Science University, Portland, Ore; Cardiovascular Division (C.P.H.), Beth Israel Deaconess Medical Center, Boston, Mass; and Cardiovascular Division (J.C.F.), University Hospital-Case Medical Center, Cleveland, Ohio
| | - Jonathan N. Glickman
- From the Cardiovascular Division (J.M.G., A.S.D., C.P.H., J.N.G., M.M.G., J.C.F.), Brigham and Women’s Hospital, Boston, Mass; Cardiovascular Division (J.M.G.), Oregon Health and Science University, Portland, Ore; Cardiovascular Division (C.P.H.), Beth Israel Deaconess Medical Center, Boston, Mass; and Cardiovascular Division (J.C.F.), University Hospital-Case Medical Center, Cleveland, Ohio
| | - Michael M. Givertz
- From the Cardiovascular Division (J.M.G., A.S.D., C.P.H., J.N.G., M.M.G., J.C.F.), Brigham and Women’s Hospital, Boston, Mass; Cardiovascular Division (J.M.G.), Oregon Health and Science University, Portland, Ore; Cardiovascular Division (C.P.H.), Beth Israel Deaconess Medical Center, Boston, Mass; and Cardiovascular Division (J.C.F.), University Hospital-Case Medical Center, Cleveland, Ohio
| | - James C. Fang
- From the Cardiovascular Division (J.M.G., A.S.D., C.P.H., J.N.G., M.M.G., J.C.F.), Brigham and Women’s Hospital, Boston, Mass; Cardiovascular Division (J.M.G.), Oregon Health and Science University, Portland, Ore; Cardiovascular Division (C.P.H.), Beth Israel Deaconess Medical Center, Boston, Mass; and Cardiovascular Division (J.C.F.), University Hospital-Case Medical Center, Cleveland, Ohio
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