1
|
Ahmed MM. When RVAD Isn't a Four-Letter Word. ASAIO J 2024; 70:578. [PMID: 38833526 DOI: 10.1097/mat.0000000000002248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Affiliation(s)
- Mustafa M Ahmed
- From the Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| |
Collapse
|
2
|
Sciaccaluga C, Procopio MC, Potena L, Masetti M, Bernazzali S, Maccherini M, Landra F, Righini FM, Cameli M, Valente S. Right ventricular dysfunction in left ventricular assist device candidates: is it time to change our prospective? Heart Fail Rev 2024; 29:559-569. [PMID: 38329583 PMCID: PMC10942886 DOI: 10.1007/s10741-024-10387-w] [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] [Accepted: 01/24/2024] [Indexed: 02/09/2024]
Abstract
The use of left ventricular assist devices (LVAD) has significantly increased in the last years, trying to offer a therapeutic alternative to heart transplantation, in light also to the significant heart donor shortage compared to the growing advanced heart failure population. Despite technological improvements in the devices, LVAD-related mortality is still fairly high, with right heart failure being one of the predominant predictors. Therefore, many efforts have been made toward a thorough right ventricular (RV) evaluation prior to LVAD implant, considering clinical, laboratory, echocardiographic, and invasive hemodynamic parameters. However, there is high heterogeneity regarding both which predictor is the strongest as well as the relative cut-off values, and a consensus has not been reached yet, increasing the risk of facing patients in which the distinction between good or poor RV function cannot be surely reached. In parallel, due to technological development and availability of mechanical circulatory support of the RV, LVADs are being considered even in patients with suboptimal RV function. The aim of our review is to analyze the current evidence regarding the role of RV function prior to LVAD and its evaluation, pointing out the extreme variability in parameters that are currently assessed and future prospective regarding new diagnostic tools. Finally, we attempt to gather the available information on the therapeutic strategies to use in the peri-operative phase, in order to reduce the incidence of RV failure, especially in patients in which the preoperative evaluation highlighted some conflicting results with regard to ventricular function.
Collapse
Affiliation(s)
- Carlotta Sciaccaluga
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
| | | | - Luciano Potena
- Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marco Masetti
- Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Sonia Bernazzali
- Department of Cardiac Surgery, University of Siena, Siena, Italy
| | | | - Federico Landra
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Francesca Maria Righini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| |
Collapse
|
3
|
Alam A, Baran DA, Doshi H, Van Zyl J, Patlolla S, Salem M, Afzal A, Al-Saffar F, Hall SA. Safety and efficacy of ProtekDuo right ventricular assist device: A systemic review. Artif Organs 2023. [PMID: 37012224 DOI: 10.1111/aor.14525] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 01/04/2023] [Accepted: 03/12/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Right ventricular failure is associated with increased morbidity and mortality. The ProtekDuo (Livanova, Uk) is a dual-lumen cannula that allows for percutaneous right ventricular support and may be connected to a centrifugal blood pump such as the TandemHeart or LifeSparc (Livanova, UK). This systematic review aims to evaluate the safety and efficacy of ProtekDuo right ventricular support and evaluate potential clinical variables that can influence outcomes. METHODS PubMed, MEDLINE, SCOPUS, EMBASE, and the Cochrane Library were systematically searched. Studies meeting inclusion criteria, where ProtekDuo was used as the right ventricular assist device with reported numerical death counts for mortality as outcome measures. The primary endpoints were in-hospital 30-day and 1-year mortality rates. Secondary endpoints included ICU length of stay, conversion rates to surgical RVADs, ProtekDuo wean rates, duration of use of ProtekDuo, and adverse event rates. RESULTS Of 49 studies reviewed, 7 met inclusion criteria with study periods between October 2014 and November 2019. ProtekDuo was utilized due to RV failure post-LVAD insertion in 64.8% (68/105) of patients. In-hospital mortality, 30-day mortality, and 1-year mortality ranged between 9%-46%, 15%-40%, and 19%-40%, respectively. Weaning from ProtekDuo and conversion to surgical RVAD ranged between 24%-91% and 11%-35%, respectively. The ICU stay average ranged from 15.8 to 36 days and ProtekDuo mean support duration ranged from 10.5 to 58 days. CONCLUSION The ProtekDuo cannula is increasingly utilized as a right ventricular support device. Despite the sparse retrospective data available with variable patient characteristics and study design, percutaneous RV mechanical support via ProtekDuo cannula is a safe and feasible option.
Collapse
Affiliation(s)
- Amit Alam
- Center for Advanced Heart Failure and Transplant Cardiology, Baylor University Medical Center, Texas, Dallas, USA
- Texas A&M University College of Medicine, Dallas, Texas, USA
| | - David A Baran
- Cleveland Clinic Heart, Vascular and Thoracic Institute, Weston, Florida, USA
| | - Harsh Doshi
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Johanna Van Zyl
- Center for Advanced Heart Failure and Transplant Cardiology, Baylor University Medical Center, Texas, Dallas, USA
| | - Srikant Patlolla
- Center for Advanced Heart Failure and Transplant Cardiology, Baylor University Medical Center, Texas, Dallas, USA
| | - Mahmoud Salem
- University of Pittsburg Medical Center, Harrisburg, Pennsylvania, USA
| | - Aasim Afzal
- Center for Advanced Heart Failure and Transplant Cardiology, Baylor University Medical Center, Texas, Dallas, USA
- Texas A&M University College of Medicine, Dallas, Texas, USA
| | - Farah Al-Saffar
- Center for Advanced Heart Failure and Transplant Cardiology, Baylor University Medical Center, Texas, Dallas, USA
- Texas A&M University College of Medicine, Dallas, Texas, USA
| | - Shelley A Hall
- Center for Advanced Heart Failure and Transplant Cardiology, Baylor University Medical Center, Texas, Dallas, USA
- Texas A&M University College of Medicine, Dallas, Texas, USA
| |
Collapse
|
4
|
Macera F, Dewachter C, Stefanidis C, Vanden Eynden F, Bondue A, Vachiéry J, Roussoulières A. Lung diffusion capacity correlates with pre-implant pulmonary hypertension and predicts outcome after LVAD implantation. ESC Heart Fail 2023; 10:1043-1053. [PMID: 36546904 PMCID: PMC10053279 DOI: 10.1002/ehf2.14256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/26/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
AIMS Diffusing capacity of the lung for carbon monoxide (DLCO ) reduction is common in heart failure (HF) and is associated with a worse prognosis. Correlations between DLCO and pulmonary hypertension (PH) are unclear, and published data are conflicting; it has been shown that DLCO impairment may persist or even worsen after normalization of pulmonary pressures following left ventricle assist device (LVAD) implantation, maybe reflecting persistent pulmonary damage. We aimed to investigate the impact of pre-implant DLCO and central haemodynamics on outcome in patients with advanced HF implanted with a LVAD. METHODS AND RESULTS We retrospectively analysed pre-implant and post-implant data from 42 patients implanted with a LVAD at our institution. Out of 42 patients, 35 had post-capillary PH before implantation, including 17 with combined post- and pre-capillary PH (Cpc-PH). Median DLCO was 59% (IQR 47-68%), and it inversely correlated with pulmonary vascular resistance (PVR) (P 0.037) and diastolic pulmonary gradient (DPG) (P 0.042). Compared with baseline, LVAD resulted in improvement in LV diameter (LVDd, P < 0.001), mitral regurgitation (P 0.022), and PH (mPAP 24 vs. 36 mmHg, P < 0.001; PAWP 12 vs. 23 mmHg, P 0.001; pulmonary artery compliance, CPA 3.1 vs. 1.9 mL/mmHg, P 0.021). Lower DLCO and Cpc-PH at baseline were associated with a better LV reverse remodelling post-implantation (P 0.027 for LVDd) but also with a smaller gain in CPA (P 0.049). CONCLUSIONS Before LVAD implantation, DLCO impairment is associated with higher PVR and DPG, suggesting that it might be an expression of persistent pulmonary damage occurring in Cpc-PH. After LVAD implantation, both LV dimension and haemodynamics improve. Lower pre-implant DLCO is associated with better LV reverse remodelling.
Collapse
Affiliation(s)
- Francesca Macera
- Department of CardiologyHôpital Universitaire de Bruxelles – Hôpital ErasmeBrusselsBelgium
- Department of CardiologyNiguarda Ca' Granda HospitalMilanItaly
| | - Céline Dewachter
- Department of CardiologyHôpital Universitaire de Bruxelles – Hôpital ErasmeBrusselsBelgium
| | - Constantin Stefanidis
- Department of Cardiac SurgeryHôpital Universitaire de Bruxelles – Hôpital ErasmeBrusselsBelgium
| | - Frédéric Vanden Eynden
- Department of Cardiac SurgeryHôpital Universitaire de Bruxelles – Hôpital ErasmeBrusselsBelgium
| | - Antoine Bondue
- Department of CardiologyHôpital Universitaire de Bruxelles – Hôpital ErasmeBrusselsBelgium
| | - Jean‐Luc Vachiéry
- Department of CardiologyHôpital Universitaire de Bruxelles – Hôpital ErasmeBrusselsBelgium
| | - Ana Roussoulières
- Department of CardiologyHôpital Universitaire de Bruxelles – Hôpital ErasmeBrusselsBelgium
| |
Collapse
|
5
|
Zhang S, Qian ZM, Chen L, Zhao X, Cai M, Wang C, Zou H, Wu Y, Zhang Z, Li H, Lin H. Exposure to Air Pollution during Pre-Hypertension and Subsequent Hypertension, Cardiovascular Disease, and Death: A Trajectory Analysis of the UK Biobank Cohort. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:17008. [PMID: 36696106 PMCID: PMC9875843 DOI: 10.1289/ehp10967] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 11/27/2022] [Accepted: 12/15/2022] [Indexed: 05/28/2023]
Abstract
BACKGROUND The associations between air pollution exposure and morbidity and mortality of cardiovascular diseases (CVDs) have been widely reported; however, evidence on such associations across different dynamic disease trajectories remain unknown. OBJECTIVE We examined whether ambient air pollution during the prehypertension (pre-HTN) stage could aggravate the progression from hypertension (HTN) to CVD, and consequent death. METHODS A total of 168,010 adults with pre-HTN (120 - 139 mmHg systolic blood pressure or 80 - 89 mmHg diastolic blood pressure) from the UK Biobank were included in this analysis. We used a multistate model to explore the associations between five air pollutants (PM 2.5 , PM 2.5 absorbance, PM 10 , NO 2 , and NO x ) and the risk of six disease transitions (from pre-HTN to HTN, from pre-HTN to CVD, from pre-HTN to death, from HTN to CVD, from HTN to death, and from CVD to death). Mediation analyses were further conducted to explore the role of intermediate diseases in the dynamic progression of CVDs. RESULTS During a median follow-up of 12 y, 13,743 (8.18%) of participants with pre-HTN developed HTN, whereas 12,825 (7.63%) and 4,467 (2.66%) directly developed CVD or died, respectively. Air pollution was positively associated with the dynamic disease progression. For example, a per-interquartile range increase of PM 2.5 was significantly associated with the hazard ratios (HRs) of 1.105 [95% confidence intervals (CI): 1.083, 1.127], 1.045 (95% CI: 1.022, 1.068), and 1.086 (95% CI: 1.047, 1.126) in the transition from pre-HTN to HTN, CVD, and death, respectively. Higher levels of air pollution were associated with increased transition probability of disease progression. Mediation analyses indicated that intermediate diseases subsequently significantly mediated air pollutant-associated risk to develop more serious disease. CONCLUSIONS This study provides evidence that air pollution might play a role in the early stages of CVD progression. Controlling air pollution might be an effective measure to prevent CVD progression and reduce the disease burden of CVD. https://doi.org/10.1289/EHP10967.
Collapse
Affiliation(s)
- Shiyu Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zhengmin Min Qian
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA
| | - Lan Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Miao Cai
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Hongtao Zou
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yinglin Wu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zilong Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Haitao Li
- Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen, China
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
6
|
Grupper A, Kodesh A, Lavee J, Fefer P, Barbash IM, Elian D, Kogan A, Morgan A, Segev A, Maor E. Diastolic Plateau – Invasive Hemodynamic Marker of Adverse Outcome Among Left Ventricular Assist Device Patients. Front Cardiovasc Med 2022; 9:847205. [PMID: 35433856 PMCID: PMC9008249 DOI: 10.3389/fcvm.2022.847205] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDiastolic plateau is an invasive hemodynamic marker of impaired right ventricular (RV) diastolic filling. The purpose of the current analysis was to evaluate the prognostic importance of this sign in left ventricular assist device (LVAD) patients.MethodsThe analysis included all LVAD patients who received continuous-flow LVAD (HeartMate 3) at the Sheba medical center and underwent right heart catheterization (RHC) during follow up post-LVAD surgery. Patients were dichotomized into 2 mutually exclusive groups based on a plateau duration cutoff of 55% of diastole. The primary end point of the current analysis was the composite of death, heart transplantation, or increase in diuretic dosage in a 12-month follow-up period post-RHC.ResultsStudy cohort included 59 LVAD patients with a mean age of 57 (IQR 54–66) of whom 48 (81%) were males. RHC was performed at 303 ± 36 days after LVAD surgery. Patients with and without diastolic plateau had similar clinical, echocardiographic, and hemodynamic parameters. Kaplan–Meier survival analysis showed that the cumulative probability of event at 1 year was 65 ± 49% vs. 21 ± 42% for primary outcomes among patients with and without diastolic plateau (p Log rank < 0.05 for both). A multivariate model with adjustment for age, INTERMACS score and ischemic cardiomyopathy consistently showed that patients with diastolic plateau were 4 times more likely to meet the study composite end point (HR = 4.35, 95% CI 1.75–10.83, p = 0.002).ConclusionDiastolic plateau during RHC is a marker of adverse outcome among LVAD patients.
Collapse
Affiliation(s)
- Avishay Grupper
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center in Tel HaShomer, Ramat Gan, Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- *Correspondence: Avishay Grupper,
| | - Afek Kodesh
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Lavee
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center in Tel HaShomer, Ramat Gan, Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Paul Fefer
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center in Tel HaShomer, Ramat Gan, Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel M. Barbash
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center in Tel HaShomer, Ramat Gan, Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Elian
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center in Tel HaShomer, Ramat Gan, Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Kogan
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center in Tel HaShomer, Ramat Gan, Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Morgan
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center in Tel HaShomer, Ramat Gan, Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Segev
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center in Tel HaShomer, Ramat Gan, Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Maor
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center in Tel HaShomer, Ramat Gan, Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
7
|
Shad R, Quach N, Fong R, Kasinpila P, Bowles C, Castro M, Guha A, Suarez EE, Jovinge S, Lee S, Boeve T, Amsallem M, Tang X, Haddad F, Shudo Y, Woo YJ, Teuteberg J, Cunningham JP, Langlotz CP, Hiesinger W. Predicting post-operative right ventricular failure using video-based deep learning. Nat Commun 2021; 12:5192. [PMID: 34465780 PMCID: PMC8408163 DOI: 10.1038/s41467-021-25503-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/11/2021] [Indexed: 11/22/2022] Open
Abstract
Despite progressive improvements over the decades, the rich temporally resolved data in an echocardiogram remain underutilized. Human assessments reduce the complex patterns of cardiac wall motion, to a small list of measurements of heart function. All modern echocardiography artificial intelligence (AI) systems are similarly limited by design - automating measurements of the same reductionist metrics rather than utilizing the embedded wealth of data. This underutilization is most evident where clinical decision making is guided by subjective assessments of disease acuity. Predicting the likelihood of developing post-operative right ventricular failure (RV failure) in the setting of mechanical circulatory support is one such example. Here we describe a video AI system trained to predict post-operative RV failure using the full spatiotemporal density of information in pre-operative echocardiography. We achieve an AUC of 0.729, and show that this ML system significantly outperforms a team of human experts at the same task on independent evaluation.
Collapse
Affiliation(s)
- Rohan Shad
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Nicolas Quach
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Robyn Fong
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Patpilai Kasinpila
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Cayley Bowles
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Miguel Castro
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart Centre, Houston, TX, USA
| | - Ashrith Guha
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart Centre, Houston, TX, USA
| | - Erik E Suarez
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart Centre, Houston, TX, USA
| | - Stefan Jovinge
- Department of Cardiovascular Surgery, Spectrum Health Grand Rapids, Grand Rapids, MI, USA
| | - Sangjin Lee
- Department of Cardiovascular Surgery, Spectrum Health Grand Rapids, Grand Rapids, MI, USA
| | - Theodore Boeve
- Department of Cardiovascular Surgery, Spectrum Health Grand Rapids, Grand Rapids, MI, USA
| | - Myriam Amsallem
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Xiu Tang
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Francois Haddad
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Yasuhiro Shudo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Jeffrey Teuteberg
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
- Stanford Artificial Intelligence in Medicine Centre, Stanford, CA, USA
| | | | - Curtis P Langlotz
- Stanford Artificial Intelligence in Medicine Centre, Stanford, CA, USA
- Department of Radiology and Biomedical Informatics, Stanford University, Stanford, CA, USA
| | - William Hiesinger
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA.
- Stanford Artificial Intelligence in Medicine Centre, Stanford, CA, USA.
| |
Collapse
|