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Hwang B, Doyle M, Williams ML, Joshi Y, Iyer A, Watson A, Jansz P, Hayward C. Concomitant tricuspid valve surgery in patients with significant tricuspid regurgitation undergoing left ventricular assist device implantation: A systematic review and meta-analysis. Artif Organs 2024. [PMID: 38989991 DOI: 10.1111/aor.14819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 05/25/2024] [Accepted: 06/21/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Significant tricuspid regurgitation (TR) is a predictor of right heart failure (RHF) and increased mortality following left ventricular assist device (LVAD) implantation, however the benefit of tricuspid valve surgery (TVS) at the time of LVAD implantation remains unclear. This study compares early and late mortality and RHF outcomes in patients with significant TR undergoing LVAD implantation with and without concomitant TVS. METHODS A systematic search of four electronic databases was conducted for studies comparing patients with moderate or severe TR undergoing LVAD implantation with or without concomitant TVS. Meta-analysis was performed for primary outcomes of early and late mortality and RHF. Secondary outcomes included rate of stroke, renal failure, hospital and ICU length of stay. An overall survival curve was constructed using aggregated, reconstructed individual patient data from Kaplan-Meier (KM) curves. RESULTS Nine studies included 575 patients that underwent isolated LVAD and 308 patients whom received concomitant TVS. Both groups had similar rates of severe TR (46.5% vs. 45.6%). There was no significant difference seen in risk of early mortality (RR 0.90; 95% CI, 0.57-1.42; p = 0.64; I2 = 0%) or early RHF (RR 0.82; 95% CI, 0.66-1.19; p = 0.41; I2 = 57) and late outcomes remained comparable between both groups. The aggregated KM curve showed isolated LVAD to be associated with overall increased survival (HR 1.42; 95% CI, 1.05-1.93; p = 0.023). CONCLUSIONS Undergoing concomitant TVS did not display increased benefit in terms of early or late mortality and RHF in patients with preoperative significant TR. Further data to evaluate the benefit of concomitant TVS stratified by TR severity or by other predictors of RHF will be beneficial.
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Affiliation(s)
- Bridget Hwang
- Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Mathew Doyle
- Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Michael L Williams
- Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Yashutosh Joshi
- Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Arjun Iyer
- Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Alasdair Watson
- Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Paul Jansz
- Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Chris Hayward
- Department of Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
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Honda T, Takanashi M, Kitagawa A, Kimura S, Shikata F, Hirata Y, Miyaji K, Ishikura K. Quantitative Evaluation of Right Ventricular Workload Based on the Stroke Work Index in Patients after Right Ventricular Outflow Tract Reconstruction. Pediatr Cardiol 2024:10.1007/s00246-024-03499-5. [PMID: 38691140 DOI: 10.1007/s00246-024-03499-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 04/11/2024] [Indexed: 05/03/2024]
Abstract
The evaluation of right ventricular workload is sometimes complicated in patients after right ventricular outflow tract reconstruction (RVOTR) because both stenotic and regurgitation lesions are involved. In this study, we modified the right ventricular stroke work index (RVSWI) and evaluated the relationship between the modified RVSWI (mRVSWI) and patient prognosis after RVOTR.We enrolled 69 patients who underwent RVOTR (the RVOTR group), including those who needed early reoperation (early reoperation subgroup) and those who did not (follow-up subgroup), and 13 age-matched control participants (control group). Based on the catheterization results 1 year after RVOTR, we compared the mRVSWI between these groups. Additionally, we evaluated the influence of the mRVSWI on the reoperation avoidance rate and survival.The mRVSWI in the RVOTR group was significantly greater than that in the control group (17.7 ± 8.6 vs. 11.0 ± 2.7 g·m/m2, p = 0.008). The mRVSWI in the early reoperation subgroup was significantly greater than that in the follow-up subgroup (32.5 ± 11.1 vs. 15.8 ± 6.0 g·m/m2, p < 0.0001). In the follow-up subgroup, patients with an mRVSWI higher than the upper limit of normal (16.4 g·m/m2) had a greater rate of reoperation than did the other patients (p = 0.0013). One patient died suddenly, and her mRVSWI was consistently high throughout her life.We established the mRVSWI as an index that integrates the pressure and volume load on the right ventricle. Our results indicate the utility of the mRVSWI for predicting patient prognosis after RVOTR.
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Affiliation(s)
- Takashi Honda
- Department of Pediatrics, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0329, Japan.
| | - Manabu Takanashi
- Department of Pediatrics, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Atsushi Kitagawa
- Department of Pediatrics, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Sumito Kimura
- Department of Pediatrics, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Fumiaki Shikata
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Yoichiro Hirata
- Department of Pediatrics, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Kenji Ishikura
- Department of Pediatrics, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0329, Japan
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Akiyama K, Colombo PC, Stöhr EJ, Ji R, Wu IY, Itatani K, Miyazaki S, Nishino T, Nakamura N, Nakajima Y, McDonnell BJ, Takeda K, Yuzefpolskaya M, Takayama H. Blood flow kinetic energy is a novel marker for right ventricular global systolic function in patients with left ventricular assist device therapy. Front Cardiovasc Med 2023; 10:1093576. [PMID: 37260947 PMCID: PMC10228750 DOI: 10.3389/fcvm.2023.1093576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/02/2023] [Indexed: 06/02/2023] Open
Abstract
Objectives Right ventricular (RV) failure remains a major concern in heart failure (HF) patients undergoing left ventricular assist device (LVAD) implantation. We aimed to measure the kinetic energy of blood in the RV outflow tract (KE-RVOT) - a new marker of RV global systolic function. We also aimed to assess the relationship of KE-RVOT to other echocardiographic parameters in all subjects and assess the relationship of KE-RVOT to hemodynamic parameters of RV performance in HF patients. Methods Fifty-one subjects were prospectively enrolled into 4 groups (healthy controls, NYHA Class II, NYHA Class IV, LVAD patients) as follows: 11 healthy controls, 32 HF patients (8 NYHA Class II and 24 Class IV), and 8 patients with preexisting LVADs. The 24 Class IV HF patients included 21 pre-LVAD and 3 pre-transplant patients. Echocardiographic parameters of RV function (TAPSE, St', Et', IVA, MPI) and RV outflow color-Doppler images were recorded in all patients. Invasive hemodynamic parameters of RV function were collected in all Class IV HF patients. KE-RVOT was derived from color-Doppler imaging using a vector flow mapping proprietary software. Kruskal-Wallis test was performed for comparison of KE-RVOT in each group. Correlation between KE-RVOT and echocardiographic/hemodynamic parameters was assessed by linear regression analysis. Receiver operating characteristic curves for the ability of KE-RVOT to predict early phase RV failure were generated. Results KE-RVOT (median ± IQR) was higher in healthy controls (55.10 [39.70 to 76.43] mW/m) than in the Class II HF group (22.23 [15.41 to 35.58] mW/m, p < 0.005). KE-RVOT was further reduced in the Class IV HF group (9.02 [5.33 to 11.94] mW/m, p < 0.05). KE-RVOT was lower in the LVAD group (25.03 [9.88 to 38.98] mW/m) than the healthy controls group (p < 0.005). KE-RVOT had significant correlation with all echocardiographic parameters and no correlation with invasive hemodynamic parameters. RV failure occurred in 12 patients who underwent LVAD implantation in the Class IV HF group (1 patient was not eligible due to death immediately after the LVAD implantation). KE-RVOT cut-off value for prediction of RV failure was 9.15 mW/m (sensitivity: 0.67, specificity: 0.75, AUC: 0.66). Conclusions KE-RVOT, a novel noninvasive measure of RV function, strongly correlates with well-established echocardiographic markers of RV performance. KE-RVOT is the energy generated by RV wall contraction. Therefore, KE-RVOT may reflect global RV function. The utility of KE-RVOT in prediction of RV failure post LVAD implantation requires further study.
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Affiliation(s)
- Koichi Akiyama
- Department of Anesthesiology, Kindai University Hospital, Osakasayama, Japan
- Department of Medicine, Division of Cardiothoracic and Vascular Surgery, Columbia University Irving Medical Center, New York, NY, United States
| | - Paolo C. Colombo
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, United States
| | - Eric J. Stöhr
- COR-HELIX (CardiOvascular Regulation and Exercise Laboratory-Integration and Xploration), Institute of Sport Science, Leibniz University Hannover, Hannover, Germany
| | - Ruiping Ji
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, United States
| | - Isaac Y. Wu
- Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY, United States
| | - Keiichi Itatani
- Department of Cardiovascular Surgery, Nagoya City University, Nagoya, Japan
| | | | | | - Naotoshi Nakamura
- iBLab (interdisciplinary Biology Laboratory), Division of Natural Science, Graduate School of Science, Nagoya University, Nagoya, Japan
| | - Yasufumi Nakajima
- Department of Anesthesiology, Kindai University Hospital, Osakasayama, Japan
| | - Barry J McDonnell
- School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Koji Takeda
- Department of Medicine, Division of Cardiothoracic and Vascular Surgery, Columbia University Irving Medical Center, New York, NY, United States
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, United States
| | - Hiroo Takayama
- Department of Medicine, Division of Cardiothoracic and Vascular Surgery, Columbia University Irving Medical Center, New York, NY, United States
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Takenaka S, Sato T, Nagai T, Omote K, Kobayashi Y, Kamiya K, Konishi T, Tada A, Mizuguchi Y, Takahashi Y, Naito S, Saiin K, Ishizaka S, Wakasa S, Anzai T. Impact of right ventricular reserve on exercise capacity and quality of life in patients with left ventricular assist device. Am J Physiol Heart Circ Physiol 2023; 324:H355-H363. [PMID: 36705992 DOI: 10.1152/ajpheart.00626.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Although measuring right ventricular (RV) function during exercise is more informative than assessing it at rest, the relationship between RV reserve function, exercise capacity, and health-related quality of life (HRQoL) in patients with left ventricular assist devices (LVAD) remains unresolved. We aimed to investigate whether RV reserve assessed by the change in RV stroke work index (RVSWI) during exercise is correlated with exercise capacity and HRQoL in patients with LVAD. We prospectively assessed 24 consecutive patients with LVAD who underwent invasive right heart catheterization in the supine position. Exercise capacity and HRQoL were assessed using the 6-min walk distance (6 MWD) and peak oxygen consumption (V̇o2) in cardiopulmonary exercise testing, and the EuroQol visual analog scale (EQ-VAS), respectively. The patients were divided into two groups according to the median ΔRVSWI (change from rest to peak exercise). Patients with lower ΔRVSWI had significantly lower changes in cardiac index and absolute value of RV dP/dt than those with higher ΔRVSWI. The ΔRVSWI was positively correlated with 6 MWD (r = 0.59, P = 0.003) and peak V̇o2 (r = 0.56, P = 0.006). In addition, ΔRVSWI was positively correlated with the EQ-VAS (r = 0.44, P = 0.030). In contrast, there was no significant correlation between RVSWI at rest and 6 MWD (r = -0.34, P = 0.88), peak V̇o2 (r = 0.074, P = 0.74), or EQ-VAS (r = 0.127, P = 0.56). Our findings suggest that the assessment of RV reserve function is useful for risk stratification in patients with LVAD.NEW & NOTEWORTHY The change in right ventricular stroke work index (RVSWI) during exercise, not RVSWI at rest, was associated with exercise capacity and HRQoL. Our findings suggest that the assessment of change in RVSWI during exercise as a surrogate of RV reserve function may aid in risk stratification of patients with LVAD.
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Affiliation(s)
- Sakae Takenaka
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takuma Sato
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazunori Omote
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuta Kobayashi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kiwamu Kamiya
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takao Konishi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Atsushi Tada
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshifumi Mizuguchi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuki Takahashi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Seiichiro Naito
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kohei Saiin
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Suguru Ishizaka
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoru Wakasa
- Department of Cardiovascular Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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5
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Kuroda T, Miyagi C, Fukamachi K, Karimov JH. Biventricular assist devices and total artificial heart: Strategies and outcomes. Front Cardiovasc Med 2023; 9:972132. [PMID: 36684573 PMCID: PMC9853410 DOI: 10.3389/fcvm.2022.972132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/14/2022] [Indexed: 01/09/2023] Open
Abstract
In contrast to the advanced development of the left ventricular assist device (LVAD) therapy for advanced heart failure, the mechanical circulatory support (MCS) with biventricular assist device (BVAD) and total artificial heart (TAH) options remain challenging. The treatment strategy of BVAD and TAH therapy largely depends on the support duration. For example, an extracorporeal centrifugal pump, typically referred to as a temporary surgical extracorporeal right ventricular assist device, is implanted for the short term with acute right ventricular failure following LVAD implantation. Meanwhile, off-label use of a durable implantable LVAD is a strategy for long-term right ventricular support. Hence, this review focuses on the current treatment strategies and clinical outcomes based on each ventricle support duration. In addition, the issue of heart failure post-heart transplantation (post-HT) is explored. We will discuss MCS therapy options for post-HT recipients.
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Affiliation(s)
- Taiyo Kuroda
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Chihiro Miyagi
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Kiyotaka Fukamachi
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
| | - Jamshid H. Karimov
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States,*Correspondence: Jamshid H. Karimov,
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6
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James L, Smith DE. Supporting the "forgotten" ventricle: The evolution of percutaneous RVADs. Front Cardiovasc Med 2023; 9:1008499. [PMID: 36684567 PMCID: PMC9845717 DOI: 10.3389/fcvm.2022.1008499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/30/2022] [Indexed: 01/06/2023] Open
Abstract
Right heart failure (RHF) can occur as the result of an acute or chronic disease process and is a challenging clinical condition for surgeons and interventionalists to treat. RHF occurs in approximately 0.1% of patients after cardiac surgery, in 2-3% of patients following heart transplantation, and in up to 42% of patients after LVAD implantation. Regardless of the cause, RHF portends high morbidity and mortality and is associated with longer hospital stays and higher healthcare costs. The mainstays of traditional therapy for severe RHF have included pharmacological support, such as inotropes and vasopressors, and surgical right ventricular (RV) assist devices. However, in recent years catheter-based mechanical circulatory support (MCS) strategies have offered novel solutions for addressing RHF without the morbidity of open surgery. This manuscript will review the pathophysiology of RHF, including the molecular underpinnings, gross structural mechanisms, and hemodynamic consequences. The evolution of techniques for supporting the right ventricle will be explored, with a focus on various institutional experiences with percutaneous ventricular assist devices.
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7
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Read JM, Azih NI, Peters CJ, Gurtu V, Vishram-Nielsen JK, Wright SP, Alba AC, Gregoski MJ, Pilch NA, Hsu S, Genuardi MV, Inampudi C, Jackson GR, Pope N, Witer LP, Kilic A, Houston BA, Mak S, Birati EY, Tedford RJ. Hemodynamic reserve predicts early right heart failure after LVAD implantation. J Heart Lung Transplant 2022; 41:1716-1726. [PMID: 35934606 PMCID: PMC10729844 DOI: 10.1016/j.healun.2022.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/09/2022] [Accepted: 07/05/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Early right heart failure (RHF) remains a major source of morbidity and mortality after left ventricular assist device (LVAD) implantation, yet efforts to predict early RHF have proven only modestly successful. Pharmacologic unloading of the left ventricle may be a risk stratification approach allowing for assessment of right ventricular and hemodynamic reserve. METHODS We performed a multicenter, retrospective analysis of patients who had undergone continuous-flow LVAD implantation from October 2011 to April 2020. Only those who underwent vasodilator testing with nitroprusside during their preimplant right heart catheterization were included (n = 70). Multivariable logistic regression was used to determine independent predictors of early RHF as defined by Mechanical Circulatory Support-Academic Research Consortium. RESULTS Twenty-seven patients experienced post-LVAD early RHF (39%). Baseline clinical characteristics were similar between patients with and without RHF. Patients without RHF, however, achieved higher peak stroke volume index (SVI) (30.1 ± 8.8 vs 21.7 ± 7.4 mL/m2; p < 0.001; AUC: 0.78; optimal cut-point: 22.1 mL/m2) during nitroprusside administration. Multivariable analysis revealed that peak SVI was significantly associated with early RHF, demonstrating a 16% increase in risk of early RHF per 1 ml/m2 decrease in SVI. A follow up cohort of 10 consecutive patients from July 2020 to October 2021 resulted in all patients being categorized appropriately in regards to early RHF versus no RHF according to peak SVI. CONCLUSION Peak SVI with nitroprusside administration was independently associated with post-LVAD early RHF while resting hemodynamics were not. Vasodilator testing may prove to be a strong risk stratification tool when assessing LVAD candidacy though additional prospective validation is needed.
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Affiliation(s)
| | | | - Carli J Peters
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Vikram Gurtu
- Division of Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Julie K Vishram-Nielsen
- Division of Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Stephen P Wright
- Division of Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Ana Carolina Alba
- Division of Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Mathew J Gregoski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Nicole A Pilch
- Deparment of Pharmacy, Medical University of South Carolina, Charleston, SC
| | - Steven Hsu
- Division of Cardiology, Department of Medicine, John Hopkins School of Medicine, Baltimore, MD
| | - Michael V Genuardi
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Gregory R Jackson
- Division of Cardiology, Medical University of South Carolina, Charleston, SC
| | - Nicholas Pope
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Lucas P Witer
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Arman Kilic
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Brian A Houston
- Division of Cardiology, Medical University of South Carolina, Charleston, SC
| | - Susanna Mak
- Division of Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Edo Y Birati
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Cardiovascular Division, Poriya Medical Center, Bar Ilan University, Isreal
| | - Ryan J Tedford
- Division of Cardiology, Medical University of South Carolina, Charleston, SC.
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8
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Bravo CA, Navarro AG, Dhaliwal KK, Khorsandi M, Keenan JE, Mudigonda P, O'Brien KD, Mahr C. Right heart failure after left ventricular assist device: From mechanisms to treatments. Front Cardiovasc Med 2022; 9:1023549. [PMID: 36337897 PMCID: PMC9626829 DOI: 10.3389/fcvm.2022.1023549] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/22/2022] [Indexed: 07/21/2023] Open
Abstract
Left ventricular assist device (LVAD) therapy is a lifesaving option for patients with medical therapy-refractory advanced heart failure. Depending on the definition, 5-44% of people supported with an LVAD develop right heart failure (RHF), which is associated with worse outcomes. The mechanisms related to RHF include patient, surgical, and hemodynamic factors. Despite significant progress in understanding the roles of these factors and improvements in surgical techniques and LVAD technology, this complication is still a substantial cause of morbidity and mortality among LVAD patients. Additionally, specific medical therapies for this complication still are lacking, leaving cardiac transplantation or supportive management as the only options for LVAD patients who develop RHF. While significant effort has been made to create algorithms aimed at stratifying risk for RHF in patients undergoing LVAD implantation, the predictive value of these algorithms has been limited, especially when attempts at external validation have been undertaken. Perhaps one of the reasons for poor performance in external validation is related to differing definitions of RHF in external cohorts. Additionally, most research in this field has focused on RHF occurring in the early phase (i.e., ≤1 month) post LVAD implantation. However, there is emerging recognition of late-onset RHF (i.e., > 1 month post-surgery) as a significant cause of morbidity and mortality. Late-onset RHF, which likely has a unique physiology and pathogenic mechanisms, remains poorly characterized. In this review of the literature, we will describe the unique right ventricular physiology and changes elicited by LVADs that might cause both early- and late-onset RHF. Finally, we will analyze the currently available treatments for RHF, including mechanical circulatory support options and medical therapies.
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Affiliation(s)
- Claudio A. Bravo
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Andrew G. Navarro
- School of Medicine, University of Washington, Seattle, WA, United States
| | - Karanpreet K. Dhaliwal
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA, United States
| | - Maziar Khorsandi
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA, United States
| | - Jeffrey E. Keenan
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA, United States
| | - Parvathi Mudigonda
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Kevin D. O'Brien
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Claudius Mahr
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, United States
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9
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Goodin MS, Showalter M, Horvath DJ, Kuban BD, Flick CR, Polakowski AR, Fukamachi K, Karimov JH. Characterization and Development of Universal Ventricular Assist Device: Computational Fluid Dynamics Analysis of Advanced Design. ASAIO J 2022; 68:1024-1035. [PMID: 34772847 PMCID: PMC9085974 DOI: 10.1097/mat.0000000000001607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We are developing a universal, advanced ventricular assist device (AVAD) with automatic pressure regulation suitable for both left and right ventricular support. The primary goal of this computational fluid dynamics (CFD) study was to analyze the biventricular performance of the AVAD across its wide range of operating conditions. An AVAD CFD model was created and validated using in vitro hydraulic performance measurements taken over conditions spanning both left ventricular assist device (LVAD) and right ventricular assist device (RVAD) operation. Static pressure taps, placed throughout the pump, were used to validate the CFD results. The CFD model was then used to assess the change in hydraulic performance with varying rotor axial positions and identify potential design improvements. The hydraulic performance was simulated and measured at rotor speeds from 2,300 to 3,600 revolutions/min and flow rates from 2.0 to 8.0 L/min. The CFD-predicted hydraulic pressure rise agreed well with the in vitro measured data, within 6.5% at 2300 rpm and within 3.5% for the higher rotor speeds. The CFD successfully predicted wall static pressures, matching experimental values within 7%. High degree of similarity and circumferential uniformity in the pump's flow fields were observed over the pump operation as an LVAD and an RVAD. A secondary impeller axial clearance reduction resulted in a 10% decrease in peak flow residence time and lower static pressures on the secondary impeller. These lower static pressures suggest a reduction in the upwards rotor forces from the secondary impeller and a desired increase in the pressure sensitivity of the pump. The CFD analyses supported the feasibility of the proposed AVAD's use as an LVAD or an RVAD, over a wide range of operating conditions. The CFD results demonstrated the operability of the pump in providing the desired circumferential flow similarity over the intended range of flow/speed conditions and the intended functionality of the AVAD's automated pressure regulation.
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Affiliation(s)
| | | | | | - Barry D. Kuban
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Christine R. Flick
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Anthony R. Polakowski
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Kiyotaka Fukamachi
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Jamshid H. Karimov
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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10
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Essandoh M, Kumar N, Hussain N, Dalia AA, Wang D, Al-Qudsi O, Wilsak D, Stahl D, Bhatt A, Sawyer TR, Iyer MH. Pulmonary Artery Pulsatility Index as a Predictor of Right Ventricular Failure in Left Ventricular Assist Device Recipients: A Systematic Review. J Heart Lung Transplant 2022; 41:1114-1123. [DOI: 10.1016/j.healun.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 12/25/2022] Open
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11
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Avci G, Nalbantgil S, Kemal H, Ertugay S, Engin C, Yagdi T, Ozabaran M. Preoperative and perioperative predictors of right ventricular failure after left ventricular assist device implantation. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2022. [DOI: 10.4103/ijca.ijca_2_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Outcomes of Ambulatory Heart Failure Patients Managed With an Intra-aortic Balloon Pump Before Left Ventricular Assist Device Implantation. ASAIO J 2021; 67:430-435. [PMID: 33769998 DOI: 10.1097/mat.0000000000001249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Patients are admitted to the hospital for hemodynamic optimization before left ventricular assist device (LVAD) implantation. The aim of this study was to evaluate the clinical outcomes of hemodynamic optimization using an intra-aortic balloon pump (IABP) in ambulatory heart failure patients before LVAD placement. This retrospective single-center study included 199 noninotrope-dependent patients who underwent durable LVAD implantation between January 1, 2007 and April 10, 2017. Invasive hemodynamic as well as the primary composite end-point of stage 2 or 3 acute kidney injury, right ventricular failure, and 30-day mortality were compared between patients with and without an IABP. Median age was 64 (interquartile range [IQR], 57-71) years and 165 (82.9%) were male; 72 (36.2%) received an IABP. Patients treated with an IABP had worse baseline exercise capacity and hemodynamic parameters. Patients with an IABP had greater relative reduction in pulmonary artery mean pressure (-16% vs. -2%; p ≤ 0.001). The primary composite end-point was not different between patients who had an IABP and those who did not (20.8% vs. 20.5%; p = 0.952), as were each of the individual end-points. Despite worse baseline hemodynamic parameters and exercise capacity, ambulatory heart failure patients who received an IABP before LVAD implantation had more favorable reductions in pulmonary artery pressures without an increase in the composite end-point. These results suggest that IABP use before LVAD implantation may mitigate the risk of postoperative complications in ambulatory patients.
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13
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Nakazato T, Yoshioka D, Toda K, Miyagawa S, Kainuma S, Kawamura T, Kawamura A, Kashiyama N, Ueno T, Kuratani T, Sakata Y, Sawa Y. Impact of tricuspid regurgitation on late right ventricular failure in left ventricular assist device patients ~can prophylactic tricuspid annuloplasty prevent late right ventricular failure? ~. J Cardiothorac Surg 2021; 16:99. [PMID: 33879203 PMCID: PMC8056678 DOI: 10.1186/s13019-021-01492-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 04/08/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In this study, we evaluated the prevalence of tricuspid regurgitation (TR) worsening in patients with left ventricular assist devices (LVADs) and its impact on late right ventricular (RV) failure. METHODS We enrolled 147 patients of the 184 patients who underwent continuous-flow LVAD implantations from 2005 to March 2018. The prevalence of postoperative TR worsening and late RV failure were retrospectively evaluated. RESULTS Concomitant tricuspid annuloplasty (TAP) was performed in 28 of 41 patients (68%) with preoperative TR greater than or equal to moderate (TR group) and in 23 of 106 patients (22%) with preoperative TR less than or equal to mild (non-TR group). Regarding the TR-free rates, despite receiving or not receiving concomitant TAP, there was no significant difference between the 2 groups (TR group: p = 0.37; non-TR group: p = 0.42). Of the 9 patients with postoperative TR greater than or equal to moderate, late RV failure developed in 3 patients, with TR worsening after RV failure in each case. During follow-up, 16 patients (11%) had late RV failure. As for the late RV failure-free rates, despite receiving or not receiving concomitant TAP, there was no significant difference between the 2 groups (TR group: p = 0.37; non-TR group: p = 0.96). CONCLUSIONS TR prognosis was preferable regardless of a patient receiving concomitant TAP; however, the presence of postoperative TR seemed to unrelated to late RV failure. Prophylactic TAP might not be necessary to prevent late RV failure.
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Affiliation(s)
- Taro Nakazato
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, 565-0871, Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, 565-0871, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, 565-0871, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, 565-0871, Japan
| | - Satoshi Kainuma
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, 565-0871, Japan
| | - Takuji Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, 565-0871, Japan
| | - Ai Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, 565-0871, Japan
| | - Noriyuki Kashiyama
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, 565-0871, Japan
| | - Takayoshi Ueno
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, 565-0871, Japan
| | - Toru Kuratani
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, 565-0871, Japan
| | - Yasushi Sakata
- Department of Cardiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, 565-0871, Japan.
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14
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Gonzalez MH, Wang Q, Yaranov DM, Albert C, Wolski K, Wagener J, Aggarwal A, Menon V, Jacob M, Tang W, Hsich E, Taylor D, Tong M, Soltesz E, Estep JD, Starling RC, Joyce E. Dynamic Assessment of Pulmonary Artery Pulsatility Index Provides Incremental Risk Assessment for Early Right Ventricular Failure After Left Ventricular Assist Device. J Card Fail 2021; 27:777-785. [PMID: 33640481 DOI: 10.1016/j.cardfail.2021.02.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The pulmonary artery pulsatility index (PAPi) has been studied to predict right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation, but only as a single time point before LVAD implantation. Multiple clinical factors and therapies impact RV function in pre-LVAD patients. Thus, we hypothesized that serial PAPi measurements during cardiac intensive care unit (CICU) optimization before LVAD implantation would provide incremental risk stratification for early RVF after LVAD implantation. METHODS AND RESULTS Consecutive patients who underwent sequential pulmonary artery catherization with cardiac intensive care optimization before durable LVAD implantation were included. Serial hemodynamics were reviewed retrospectively across the optimization period. The optimal PAPi was defined by the initial PAPi + the PAPi at optimized hemodynamics. RVF was defined as need for a right ventricular assist device or prolonged inotrope use (>14 days postoperatively). Patients with early RVF had significantly lower mean optimal PAPi (3.5 vs 7.5, P < .001) compared with those who did not develop RVF. After adjusting for established risk factors of early RVF after LVAD implantation, the optimal PAPi was independently and incrementally associated with early RVF after LVAD implantation (odds ratio 0.64, 95% confidence interval 0.532-0.765, P < .0001). CONCLUSIONS Optimal PAPi achieved during medical optimization before LVAD implantation provides independent and incremental risk stratification for early RVF, likely identifying dynamic RV reserve.
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Affiliation(s)
- Matthew H Gonzalez
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department of Cardiology, Spectrum Health Medical Group, Grand Rapids, Michigan.
| | - Qiuqing Wang
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Chony Albert
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kathy Wolski
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - John Wagener
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Appas Aggarwal
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Venu Menon
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Miriam Jacob
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Wilson Tang
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eileen Hsich
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - David Taylor
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael Tong
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edward Soltesz
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jerry D Estep
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Emer Joyce
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
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15
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Lo Coco V, De Piero ME, Massimi G, Chiarini G, Raffa GM, Kowalewski M, Maessen J, Lorusso R. Right ventricular failure after left ventricular assist device implantation: a review of the literature. J Thorac Dis 2021; 13:1256-1269. [PMID: 33717597 PMCID: PMC7947472 DOI: 10.21037/jtd-20-2228] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Right ventricular failure (RVF) following left ventricular assist device (LVAD) implantation remains a major complication which may significantly impair patient outcome. The genesis of RVF is, however, multifactorial, and the mechanisms underlying such a condition have not been fully elucidated, making its prevention challenging and the course not always predictable. Although preoperative risks factors can be associated with RV impairment, the physiologic changes after the LV support, can still hamper the function of the RV. Current medical treatment options are limited and sometimes, patients with a severe post-LVAD RVF may be unresponsive to pharmacological therapy and require more aggressive treatment, such as temporary RV support. We retrieved 11 publications which we assessed and divided in groups based on the RV support [extracorporeal membrane oxygenation (ECMO), right ventricular assist device (RVAD), TandemHeart with ProtekDuo cannula]. The current review comprehensively summarizes the main studies of the literature with particular attention to the RV physiology and its changes after the LVAD implantation, the predictors and prognostic score as well as the different modalities of temporary mechanical cardio-circulatory support, and its effects on patient prognosis for RVF in such a setting. In addition, it provides a decision making of the pre-, intra and post-operative management in high- and moderate- risk patients.
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Affiliation(s)
- Valeria Lo Coco
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Maria Elena De Piero
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Anesthesia/Intensive Care, San Giovanni, Turin, Italy
| | - Giulio Massimi
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Cardiac Surgery, Circolo Hospital, University of Insurbia, Varese, Italy
| | - Giovanni Chiarini
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.,Division of Anesthesiology, Intensive Care and Emergency medicine, Spedali Civili University, Brescia, Italy
| | - Giuseppe M Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Mariusz Kowalewski
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.,Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
| | - Jos Maessen
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
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16
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Impact of right ventricular stroke work index on predicting hospital readmission and functional status of patients with advanced heart failure. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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17
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Ozenc E, Yildiz O, Baydar O, Yazicioglu N, Koc NA. Impact of right ventricular stroke work index on predicting hospital readmission and functional status of patients with advanced heart failure. Rev Port Cardiol 2020; 39:565-572. [PMID: 33008692 DOI: 10.1016/j.repc.2020.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/25/2019] [Accepted: 06/11/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION AND AIMS The prognosis of chronic heart failure with reduced ejection fraction (HFrEF) has been studied extensively, but factors predicting cardiac decompensation are poorly defined. Right ventricular stroke work index (RVSWI), an invasive measure of right ventricular (RV) systolic function, is a well-known prognostic marker of RV failure after left ventricular assist device insertion and after lung transplantation. Thus, the aim of this study was to assess whether there is a relationship between RVSWI, HFrEF hospital readmission due to cardiac decompensation, and prognosis. METHODS We prospectively enrolled 132 consecutive patients with HFrEF. Right heart catheterization was performed and RVSWI values were calculated in all patients. The relationship between RVSWI values and readmission and prognosis was analyzed. RESULTS During a median follow-up of 20±7 months, 33 patients were readmitted due to cardiac decompensation in the survivor group, and 18 patients died due to cardiac causes. There was no difference between patients who died and survived in terms of RVSWI values. Among patients with decompensation, mean RVSWI was significantly lower than in patients with stable HFrEF (6.0±2.2 g/m2/beat vs. 8.8±3.5 g/m2/beat, p<0.001). On correlation analysis, RVSWI was negatively correlated with NYHA functional class. RVSWI was also identified as an independent risk factor for cardiac decompensation in Cox regression survival analysis. CONCLUSIONS We showed that RVSWI predicts cardiac decompensation and correlates with functional class in advanced stage HFrEF. Our data suggest the value of combining information on right heart hemodynamics with assessment of RV function when defining the risk of patients with advanced HFrEF.
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Affiliation(s)
- Ebru Ozenc
- Department of Cardiology, Istanbul Bilim University, Florence Nightingale Hospital, Istanbul, Turkey
| | - Omer Yildiz
- Department of Cardiology, Istanbul Bilim University, Florence Nightingale Hospital, Istanbul, Turkey
| | - Onur Baydar
- Department of Cardiology, Koc University Hospital, Istanbul, Turkey.
| | - Nuran Yazicioglu
- Department of Cardiology, Istanbul Bilim University, Florence Nightingale Hospital, Istanbul, Turkey
| | - Nurcan Arat Koc
- Department of Cardiology, Istanbul Bilim University, Florence Nightingale Hospital, Istanbul, Turkey
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18
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Sert DE, Karahan M, Aygun E, Kocabeyoglu SS, Akdi M, Kervan U. Prediction of right ventricular failure after continuous flow left ventricular assist device implantation. J Card Surg 2020; 35:2965-2973. [DOI: 10.1111/jocs.14952] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/06/2020] [Accepted: 08/01/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Dogan Emre Sert
- Department of Cardiovascular Surgery Ankara City Hospital Ankara Turkey
| | - Mehmet Karahan
- Department of Cardiovascular Surgery Ankara City Hospital Ankara Turkey
| | - Emre Aygun
- Department of Cardiovascular Surgery Yuksekova Hospital Hakkari Turkey
| | | | - Mustafa Akdi
- Department of Cardiovascular Surgery Ankara City Hospital Ankara Turkey
| | - Umit Kervan
- Department of Cardiovascular Surgery Ankara City Hospital Ankara Turkey
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19
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Gumus F, Sarıcaoglu C, Inan MB, Akar AR. Right Ventricular Strain to Assess Early Right Heart Failure in the Left Ventricular Assist Device Candidate. Curr Heart Fail Rep 2020; 16:212-219. [PMID: 31741233 DOI: 10.1007/s11897-019-00445-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW Right heart failure (RHF) following left ventricular assist device implantation (LVAD) remains the primary cause of postoperative mortality and morbidity, and prediction of RHF is the main interest of the transplantation community. In this review, we outline the role and impact of right ventricular strain in the evaluation of the right ventricle function before LVAD implantation. RECENT FINDINGS Accumulating data suggest that measurement of right ventricular longitudinal strain (RVLS) has a critical role in predicting RHF preoperatively and may improve morbidity and mortality following LVAD implantation. However, the significant intraobserver, interobserver variability, the lack of multicenter, prospective studies, and the need for a learning curve remain the most critical limitations in the clinical practice at present. This review highlighted the importance of right ventricular strain in the diagnosis of RHF preoperatively and revealed that RVLS might have a crucial clinical measurement for the selection and management of LVAD patients in the future with the more extensive multicenter studies.
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Affiliation(s)
- Fatih Gumus
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Dikimevi, 06340, Ankara, Turkey
| | - Cahit Sarıcaoglu
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Dikimevi, 06340, Ankara, Turkey
| | - Mustafa Bahadir Inan
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Dikimevi, 06340, Ankara, Turkey
| | - Ahmet Ruchan Akar
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Dikimevi, 06340, Ankara, Turkey.
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20
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Dandel M, Javier MFDM, Javier Delmo EMD, Hetzer R. Accurate assessment of right heart function before and after long-term left ventricular assist device implantation. Expert Rev Cardiovasc Ther 2020; 18:289-308. [DOI: 10.1080/14779072.2020.1761790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Michael Dandel
- Department of Cardiology, Cardio Centrum Berlin, Berlin, Germany
| | | | | | - Roland Hetzer
- Department of Cardiothoracic and Vascular Surgery, Cardio Centrum Berlin, Berlin, Germany
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21
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Chung JS, Emerson D, Megna D, Arabia FA. Total artificial heart: surgical technique in the patient with normal cardiac anatomy. Ann Cardiothorac Surg 2020; 9:81-88. [PMID: 32309155 DOI: 10.21037/acs.2020.02.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Heart failure is a complex, growing problem with significant morbidity and mortality. Though heart transplantation remains the gold standard treatment for end-stage heart failure, there remains a national shortage of donor hearts. Mechanical circulatory support has provided an additional option for clinicians to support patients for the purposes of bridging patients to transplantation or to be used for destination therapy purposes. Despite generally favorable outcomes with univentricular support, in a subset of patients with biventricular heart failure, an isolated left ventricular assist device is not sufficient. Right ventricular failure has a negative impact on patient survival if not identified and treated promptly. The Total Artificial Heart (TAH) is the only Food and Drug Administration (FDA) approved artificial heart used for bridging patients to transplantation. Outcomes in patients who undergo implantation of the TAH at experienced centers have been good and reproducible.
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Affiliation(s)
- Joshua S Chung
- Department of Cardiothoracic Surgery, Loma Linda University Health, Loma Linda, California, USA
| | - Dominic Emerson
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dominick Megna
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Francisco A Arabia
- Advanced Heart Program, Banner University Medical Group, Phoenix, Arizona, USA
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22
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Hamdan R, Charif F, Kadri Z. Right ventricle failure in patients treated with left ventricular assist device. Ann Cardiol Angeiol (Paris) 2020; 69:51-54. [PMID: 32127195 DOI: 10.1016/j.ancard.2020.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 01/16/2020] [Indexed: 11/28/2022]
Abstract
This review article aim to highlight the right ventricular function peri left ventricular assist device implantation, and to assess the incidence, physiopathology, predictors, management and prognosis, of right ventricular failure post-implant.
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Affiliation(s)
- R Hamdan
- Cardiology department, Beirut Cardiac Institute, Beirut, Lebanon.
| | - F Charif
- Pneumology, Beirut Cardiac Institute, Beirut, Lebanon
| | - Z Kadri
- Cardiology department, Hôtel-Dieu de France, Beirut , Lebanon
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23
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Bansal A, Akhtar F, Zwintscher NP, Ostrow S, Desai S, Fary D. Use of the Heartmate 3 for biventricular support as a bridge to heart transplant‐first US implant. J Card Surg 2019; 34:1629-1631. [DOI: 10.1111/jocs.14290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Aditya Bansal
- Section of Cardiothoracic Surgery Ochsner Clinic Foundation New Orleans Louisiana
| | - Faisal Akhtar
- Section of Cardiothoracic Surgery Ochsner Clinic Foundation New Orleans Louisiana
| | - Nathan P Zwintscher
- Section of Cardiothoracic Surgery Ochsner Clinic Foundation New Orleans Louisiana
| | - Sheila Ostrow
- Section of Cardiothoracic Surgery Ochsner Clinic Foundation New Orleans Louisiana
| | - Sapna Desai
- Section of Heart Failure Ochsner Clinic Foundation New Orleans Louisiana
| | - David Fary
- Section of Cardiothoracic Surgery Ochsner Clinic Foundation New Orleans Louisiana
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24
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Kalenderoğlu K, Güvenç TS, Mete MT, Kuplay H, Ağustos S, Güzelburç ÖÇ, Yıldırımtürk Ö, Kozan Ö, Aka SA. Usefulness of right ventricular contraction pressure index to predict short-term mortality and right heart failure in patients who underwent continuous-flow left ventricular assist device implantation. Int J Artif Organs 2019; 43:25-36. [DOI: 10.1177/0391398819868480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Right ventricular stroke work index is a useful but invasively measured parameter that can be used to predict right heart failure following continuous-flow left ventricular assist device implantation. Right ventricular contraction pressure index is a novel parameter that was developed to measure right ventricular stroke work index with echocardiography. We aimed to investigate the clinical usefulness of right ventricular contraction pressure index to predict short-term mortality and right heart failure in patients who underwent continuous-flow left ventricular assist device implantation. Methods: A total of 49 patients who participated in institutional advanced heart failure registry and underwent continuous-flow left ventricular assist device implantation with a bridge-to-candidacy indication were analyzed retrospectively. Right ventricular contraction pressure index was calculated using offline measurements. Demographic, clinical and outcome data were obtained from the registry data. Patients were grouped according to right ventricular contraction pressure index quartiles. Results: Patients within the lowest right ventricular contraction pressure index quartile had a trend toward higher short-term mortality (46.2%, p = 0.056) and combined short-term mortality and definitive right heart failure (53.8%, p = 0.054) at 15th day postoperatively. Similarly, short-term survival or survival free of definite right heart failure were significantly lower in the lowest right ventricular contraction pressure index quartile (log-rank p = 0.045 and log-rank p = 0.03, respectively). In a proportional hazards model that included echocardiographic parameters, right ventricular contraction pressure index was an independent predictor for short-term mortality (odds ratio: 6.777, 95% confidence interval: 1.118–41.098, p = 0.037), but not for combined short-term mortality and definite right heart failure. No such associations were found for long-term mortality. Right ventricular contraction pressure index had a statistically significant correlation with invasively measured pulmonary capillary wedge pressure, pulmonary vascular resistance, mean pulmonary pressure, and right ventricular stroke work index. Conclusion: Right ventricular contraction pressure index was found as a useful parameter for determining short-term postoperative mortality in patients undergoing continuous-flow left ventricular assist device implantation.
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Affiliation(s)
- Koray Kalenderoğlu
- Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | | | - Müge Taşdemir Mete
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | - Hüseyin Kuplay
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | - Semra Ağustos
- Organ Transplantation Unit, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | - Özge Çalbayram Güzelburç
- Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | - Özlem Yıldırımtürk
- Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | - Ömer Kozan
- Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | - Serap Aykut Aka
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
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25
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Tchantchaleishvili V, Maltais S, Sharma S, Haglund NA, Davis ME, Cowger J, Shah P, Desai SS, Aaronson KD, Pagani FD, Dunlay SM, Stulak JM. A novel, highly discriminatory risk model predicting acute severe right ventricular failure in patients undergoing continuous‐flow left ventricular assist device implant. Artif Organs 2019; 43:624-632. [DOI: 10.1111/aor.13413] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | - Mary E. Davis
- University of Kansas Medical Center Kansas City KS USA
| | | | - Palak Shah
- Inova Heart and Vascular Institute Falls Church VA USA
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Gumus F, Durdu MS, Cakici M, Kurklu TST, Inan MB, Dincer I, Sirlak M, Akar AR. Right ventricular free wall longitudinal strain and stroke work index for predicting right heart failure after left ventricular assist device therapy. Interact Cardiovasc Thorac Surg 2018; 28:674-682. [DOI: 10.1093/icvts/ivy328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fatih Gumus
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
| | - Mustafa Serkan Durdu
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
| | - Mehmet Cakici
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
| | - Turkan Seda Tan Kurklu
- Department of Cardiology, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
| | - Mustafa Bahadir Inan
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
| | - Irem Dincer
- Department of Cardiology, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
| | - Mustafa Sirlak
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
| | - Ahmet Ruchan Akar
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
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Interagency registry for mechanically assisted circulatory support report on the total artificial heart. J Heart Lung Transplant 2018; 37:1304-1312. [DOI: 10.1016/j.healun.2018.04.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/30/2018] [Accepted: 04/18/2018] [Indexed: 12/21/2022] Open
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Pieri M, Pappalardo F. Impella RP in the Treatment of Right Ventricular Failure: What We Know and Where We Go. J Cardiothorac Vasc Anesth 2018; 32:2339-2343. [DOI: 10.1053/j.jvca.2018.06.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Indexed: 12/21/2022]
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Silverton NA, Patel R, Zimmerman J, Ma J, Stoddard G, Selzman CH, Morrissey CK. Intraoperative Transesophageal Echocardiography and Right Ventricular Failure After Left Ventricular Assist Device Implantation. J Cardiothorac Vasc Anesth 2018; 32:2096-2103. [DOI: 10.1053/j.jvca.2018.02.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Indexed: 11/11/2022]
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Konstam MA, Kiernan MS, Bernstein D, Bozkurt B, Jacob M, Kapur NK, Kociol RD, Lewis EF, Mehra MR, Pagani FD, Raval AN, Ward C. Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e578-e622. [DOI: 10.1161/cir.0000000000000560] [Citation(s) in RCA: 335] [Impact Index Per Article: 55.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background and Purpose:
The diverse causes of right-sided heart failure (RHF) include, among others, primary cardiomyopathies with right ventricular (RV) involvement, RV ischemia and infarction, volume loading caused by cardiac lesions associated with congenital heart disease and valvular pathologies, and pressure loading resulting from pulmonic stenosis or pulmonary hypertension from a variety of causes, including left-sided heart disease. Progressive RV dysfunction in these disease states is associated with increased morbidity and mortality. The purpose of this scientific statement is to provide guidance on the assessment and management of RHF.
Methods:
The writing group used systematic literature reviews, published translational and clinical studies, clinical practice guidelines, and expert opinion/statements to summarize existing evidence and to identify areas of inadequacy requiring future research. The panel reviewed the most relevant adult medical literature excluding routine laboratory tests using MEDLINE, EMBASE, and Web of Science through September 2017. The document is organized and classified according to the American Heart Association to provide specific suggestions, considerations, or reference to contemporary clinical practice recommendations.
Results:
Chronic RHF is associated with decreased exercise tolerance, poor functional capacity, decreased cardiac output and progressive end-organ damage (caused by a combination of end-organ venous congestion and underperfusion), and cachexia resulting from poor absorption of nutrients, as well as a systemic proinflammatory state. It is the principal cause of death in patients with pulmonary arterial hypertension. Similarly, acute RHF is associated with hemodynamic instability and is the primary cause of death in patients presenting with massive pulmonary embolism, RV myocardial infarction, and postcardiotomy shock associated with cardiac surgery. Functional assessment of the right side of the heart can be hindered by its complex geometry. Multiple hemodynamic and biochemical markers are associated with worsening RHF and can serve to guide clinical assessment and therapeutic decision making. Pharmacological and mechanical interventions targeting isolated acute and chronic RHF have not been well investigated. Specific therapies promoting stabilization and recovery of RV function are lacking.
Conclusions:
RHF is a complex syndrome including diverse causes, pathways, and pathological processes. In this scientific statement, we review the causes and epidemiology of RV dysfunction and the pathophysiology of acute and chronic RHF and provide guidance for the management of the associated conditions leading to and caused by RHF.
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Dandel M, Hetzer R. Evaluation of the right ventricle by echocardiography: particularities and major challenges. Expert Rev Cardiovasc Ther 2018. [PMID: 29521112 DOI: 10.1080/14779072.2018.1449646] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Compared with the left ventricle (LV), the right ventricle (RV) is less suited for evaluation by echocardiography (ECHO). Nevertheless, RV ECHO-assessment has currently emerged as an important diagnostic tool with meaningful prognostic value and essential contribution to therapeutic decisions. Although significant progress has been made, including generation of higher-quality normative data, validation of several two-dimensional measurements and improvements in three-dimensional ECHO-techniques, many challenges in RV ECHO-assessment still persist. Areas covered: This review discusses the particular challenges and limits in obtaining accurate measurements of RV anatomical and functional parameters and focuses primarily on the difficulties in proper interpretation of the highly load dependent RV ECHO-parameters which complicates the use of this valuable diagnostic and surveillance technique. Expert commentary: There is increasing evidence that RV assessment in relation with its actual loading conditions by ECHO-derived composite variables, which either incorporate a certain functional parameter and load, or incorporate measures which reflect the relationship between RV dilation and RV load, considering also the right atrial pressure (i.e. 'load adaptation index'), is particularly suited for clinical decision-making. Load dependency of RV ECHO-parameters must be taken into consideration especially in patients with advanced RV dysfunction scheduled for LV assist device implantation or lung transplantation.
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Affiliation(s)
- Michael Dandel
- a German Centre for Heart and Circulatory Research (DZHK) , Partner site Berlin , Germany.,b Deutsches Herzzentrum Berlin , Germany
| | - Roland Hetzer
- b Deutsches Herzzentrum Berlin , Germany.,c Cardio Centrum Berlin , Germany
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Berdat PA, Gygax E, Nydegger U, Carrel T. Short- and long-term mechanical cardiac assistance. Int J Artif Organs 2018. [DOI: 10.1177/039139880102400504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
With the increase in high risk patients undergoing cardiac surgery and the substantial mortality among patients waiting for cardiac transplantation, the need for mechanical circulatory support is growing. Several devices are currently available, ranging from the intra-aortic balloon pump to fully implantable ventricular assist devices. Each system has its own features, and proper patient selection as well as the timing of implantation is sometimes difficult. Algorithms for stepwise management in subgroups of patients remain controversial and the concepts of weaning patients after myocardial recovery during mechanical circulatory support need further evaluation for their long-term effects. Future identification of valuable prognostic and risk factors may help in decision-making and allow for improved survival of these often very ill patients. In this report we review the concepts of mechanical circulatory support at our institution with emphasis on a detailed overview of technical features of extracorporeal life support.
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Affiliation(s)
- P. A. Berdat
- Department of Cardiovascular Surgery, University Hospital, Bern - Switzerland
| | - E. Gygax
- Department of Cardiovascular Surgery, University Hospital, Bern - Switzerland
| | - U. Nydegger
- Department of Cardiovascular Surgery, University Hospital, Bern - Switzerland
| | - T. Carrel
- Department of Cardiovascular Surgery, University Hospital, Bern - Switzerland
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Biventricular Support With Intracorporeal, Continuous Flow, Centrifugal Ventricular Assist Devices. Ann Thorac Surg 2018; 105:548-555. [DOI: 10.1016/j.athoracsur.2017.08.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/27/2017] [Accepted: 08/07/2017] [Indexed: 11/20/2022]
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Frequency and Consequences of Right-Sided Heart Failure After Continuous-Flow Left Ventricular Assist Device Implantation. Am J Cardiol 2018; 121:336-342. [PMID: 29223289 DOI: 10.1016/j.amjcard.2017.10.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 11/21/2022]
Abstract
Postoperative right-sided heart failure (RHF) is a common complication after continuous-flow left ventricular assist device implantation. Studies have examined RHF in the perioperative period, but few have assessed late-onset RHF. We analyzed the incidence of early and late RHF in patients with HeartMate II and HeartWare left ventricular assist devices and associated morbidity, mortality, and independent predictors of RHF. We retrospectively analyzed records of 526 patients with chronic heart failure who underwent continuous-flow left ventricular assist device implantation; 147 (27.9%) developed RHF (early RHF, n = 87, 16.5%; late RHF, n = 74, 14.4%). We examined demographics, postoperative complications, and long-term survival rate. Patients with RHF or late RHF had higher mortality (p <0.001) than those without RHF. Patients with RHF had a higher incidence of acute kidney injury (20.4% vs 11.9%, p = 0.01). Device type did not affect the incidence of early, late, or overall RHF. Patients with severe RHF requiring right ventricular assist device support had a low success of bridge to transplantation (11.1% vs 33.3%, p = 0.02). In Cox regression models, RHF was an independent predictor of mortality (hazard ratio = 1.69, 95% confidence interval = 1.28 to 2.22, p <0.001), but no predictive variables of RHF were identified. RHF was significantly associated with increased mortality and a higher incidence of postoperative acute kidney injury. RHF decreased the success rate of bridging patients to transplantation when a right ventricular assist device was required.
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Application of multiobjective neural predictive control to biventricular assistance using dual rotary blood pumps. Biomed Signal Process Control 2018. [DOI: 10.1016/j.bspc.2017.07.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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36
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Bilchick KC, Mejia-Lopez E, McCullough P, Breathett K, Kennedy JL, Tallaj J, Bergin J, Pamboukian S, Abuannadi M, Mazimba S. Clinical Impact of Changes in Hemodynamic Indices of Contractile Function During Treatment of Acute Decompensated Heart Failure. J Card Fail 2018; 24:43-50. [DOI: 10.1016/j.cardfail.2017.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/30/2017] [Accepted: 07/06/2017] [Indexed: 11/16/2022]
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37
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Jensen CW, Goldstone AB, Woo YJ. Treatment and Prognosis of Pulmonary Hypertension in the Left Ventricular Assist Device Patient. Curr Heart Fail Rep 2017; 13:140-50. [PMID: 27241336 DOI: 10.1007/s11897-016-0288-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This review will discuss the medical management of pulmonary hypertension in patients with left ventricular assist devices. Although much has been written on the management of primary pulmonary hypertension, also called pulmonary arterial hypertension, this review will instead focus on the treatment of pulmonary hypertension secondary to left heart disease. The relevant pharmacotherapy can be divided into medications for treating heart failure, such as diuretics and β-blockers, and medications for treating pulmonary hypertension. We also discuss important preoperative considerations in patients with pulmonary hypertension; the relationships between left ventricular assist devices, pulmonary hemodynamics, and right heart failure; as well as optimal perioperative and long-term postoperative medical management of pulmonary hypertension.
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Affiliation(s)
- Christopher W Jensen
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Andrew B Goldstone
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA. .,Department of Bioengineering, Stanford University, Falk Building CV-235, 300 Pasteur Drive, Stanford, CA, 94305-5407, USA.
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38
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Loforte A, Grigioni F, Marinelli G. The risk of right ventricular failure with current continuous-flow left ventricular assist devices. Expert Rev Med Devices 2017; 14:969-983. [DOI: 10.1080/17434440.2017.1409111] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Antonio Loforte
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Francesco Grigioni
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Giuseppe Marinelli
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, Bologna University, Bologna, Italy
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Yaung J, Arabia FA, Nurok M. Perioperative Care of the Patient With the Total Artificial Heart. Anesth Analg 2017; 124:1412-1422. [PMID: 28107271 DOI: 10.1213/ane.0000000000001851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Advanced heart failure continues to be a leading cause of morbidity and mortality despite improvements in pharmacologic therapy. High demand for cardiac transplantation and shortage of donor organs have led to an increase in the utilization of mechanical circulatory support devices. The total artificial heart is an effective biventricular assist device that may be used as a bridge to transplant and that is being studied for destination therapy. This review discusses the history, indications, and perioperative management of the total artificial heart with emphasis on the postoperative concerns.
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Affiliation(s)
- Jill Yaung
- From the *Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California; and †Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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Cameli M, Loiacono F, Sparla S, Solari M, Iardino E, Mandoli GE, Bernazzali S, Maccherini M, Mondillo S. Systematic Left Ventricular Assist Device Implant Eligibility with Non-Invasive Assessment: The SIENA Protocol. J Cardiovasc Ultrasound 2017; 25:39-46. [PMID: 28770031 PMCID: PMC5526884 DOI: 10.4250/jcu.2017.25.2.39] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/12/2017] [Accepted: 06/12/2017] [Indexed: 11/22/2022] Open
Abstract
In patients with end-stage left ventricular (LV) heart failure who receive LV assist device (LVAD) implantation, right ventricular (RV) failure represents a possible critical complication that heavily affects morbidity and mortality. Several clinical, laboratory, hemodynamic, and echocardiographic variables have been found to be associated with RV failure occurrence after surgery. Different models and risk scores have been proposed, with poor results. No accordance has ever been reached about RV pre-operative evaluation, and time has come to introduce a standardized systematic protocol for LVAD suitability assessment according to RV function. We analyzed imaging parameters associated with LVAD implantation-related RV failure, in order to identify the minimum number for pre-operative reliable prediction of post-operative RV failure. A few echocardiographic parameters have been identified as the most reliable, or promising, and reproducible tools in this field: free-wall RV longitudinal strain, RV fractional area change, RV sphericity index, and RV ejection fraction with 3D-echocardiography. We propose the Systematic LVAD Implant Eligibility with Non-invasive Assessment protocol–the SIENA protocol–as a new and simple way of pre-operative evaluation of patients candidates to LVAD implantation.
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Affiliation(s)
- Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | | | - Stefania Sparla
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - Marco Solari
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - Elisabetta Iardino
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | | | - Sonia Bernazzali
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - Massimo Maccherini
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - Sergio Mondillo
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
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Mean Arterial Pressure to Central Venous Pressure Ratio: A Novel Marker for Right Ventricular Failure After Left Ventricular Assist Device Placement. J Card Fail 2017; 23:446-452. [DOI: 10.1016/j.cardfail.2017.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 03/21/2017] [Accepted: 03/28/2017] [Indexed: 01/21/2023]
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Bellavia D, Iacovoni A, Scardulla C, Moja L, Pilato M, Kushwaha SS, Senni M, Clemenza F, Agnese V, Falletta C, Romano G, Maalouf J, Dandel M. Prediction of right ventricular failure after ventricular assist device implant: systematic review and meta-analysis of observational studies. Eur J Heart Fail 2017; 19:926-946. [DOI: 10.1002/ejhf.733] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/11/2016] [Accepted: 11/18/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Diego Bellavia
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation; IRCCS - Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione; Palermo Italy
| | - Attilio Iacovoni
- Cardiovascular Department; Papa Giovanni XXIII Hospital; Bergamo Italy
| | - Cesare Scardulla
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation; IRCCS - Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione; Palermo Italy
| | | | - Michele Pilato
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation; IRCCS - Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione; Palermo Italy
| | - Sudhir S. Kushwaha
- Division of Cardiovascular Diseases; Mayo Clinic and Foundation; Rochester MN USA
| | - Michele Senni
- Cardiovascular Department; Papa Giovanni XXIII Hospital; Bergamo Italy
| | - Francesco Clemenza
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation; IRCCS - Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione; Palermo Italy
| | - Valentina Agnese
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation; IRCCS - Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione; Palermo Italy
| | - Calogero Falletta
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation; IRCCS - Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione; Palermo Italy
| | - Giuseppe Romano
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation; IRCCS - Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione; Palermo Italy
| | - Joseph Maalouf
- Division of Cardiovascular Diseases; Mayo Clinic and Foundation; Rochester MN USA
| | - Michael Dandel
- Department of Cardiothoracic and Vascular Surgery; Deutsches Herzzentrum; Berlin Germany
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44
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Survival After Heart Transplantation in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy. J Card Fail 2017; 23:107-112. [DOI: 10.1016/j.cardfail.2016.04.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 04/16/2016] [Accepted: 04/25/2016] [Indexed: 11/19/2022]
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45
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Aloia E, Cameli M, D'Ascenzi F, Sciaccaluga C, Mondillo S. TAPSE: An old but useful tool in different diseases. Int J Cardiol 2016; 225:177-183. [DOI: 10.1016/j.ijcard.2016.10.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 10/03/2016] [Accepted: 10/04/2016] [Indexed: 01/08/2023]
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46
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Kiernan MS, Sundareswaran KS, Pham DT, Kapur NK, Pereira NL, Strueber M, Farrar DJ, DeNofrio D, Rogers JG. Preoperative Determinants of Quality of Life and Functional Capacity Response to Left Ventricular Assist Device Therapy. J Card Fail 2016; 22:797-805. [DOI: 10.1016/j.cardfail.2016.01.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 12/07/2015] [Accepted: 01/07/2016] [Indexed: 01/14/2023]
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47
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Fox AA, Nussmeier NA. Does Gender Influence the Likelihood or Types of Complications Following Cardiac Surgery? Semin Cardiothorac Vasc Anesth 2016; 8:283-95. [PMID: 15583790 DOI: 10.1177/108925320400800403] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Over 410,000 cardiac surgeries are performed in American women each year. Women having coronary artery bypass graft (CABG) and valve surgery do so at an older age and with more cardiovascular risk factors than men. Women's smaller body size may also increase risk by increasing the technical difficulty of surgical procedures. Female CABG patients appear to have higher perioperative mortality and cardiac morbidity, although studies of neurologic outcomes in female CABG patients have produced equivocal findings. Women undergoing CABG tend to consume more hospital resources than men do in terms of blood transfusion, mechanical ventilation, and length of intensive care unit and overall hospital stay. With regard to valve surgery, women appear to have worse outcomes than men if the surgery is combined with a CABG operation. Women and men undergoing isolated aortic valve surgery have similar mortality, but little is known about gender differences in mitral and tricuspid valve surgery outcomes. Women who require heart transplantation tend to have idiopathic cardiomyopathy rather than the ischemic cardiomyopathy that is more common in male heart transplant candidates. Although female heart transplant recipients seem to have a stronger immunologic response after transplantation, which manifests in more frequent acute rejection episodes, it is not clear whether this increases women's mortality risk. Men appear to have a greater incidence of posttransplant vasculopathy than women. Further research is needed to identify risk factors for perioperative morbidity and mortality in women undergoing cardiac surgery and to develop medical interventions to mitigate these risks.
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Affiliation(s)
- Amanda A Fox
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
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48
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Abstract
Mechanical circulatory support has become an increasingly used management strategy for patients with both acute and chronic ventricular failure. This article briefly reviews the current state of mechanical circulatory support with a focus on indications, contraindications, and complications of currently available devices. Perioperative considerations for ventricular assist device implantation are discussed, including the decision-making process underlying the use of univentricular versus biventricular support, specific anesthetic considerations, and the role of transesophageal echocardiography where ventricular assist devices are concerned. The anesthetic considerations for the patient already supported by a ventricular assist device presenting for noncardiac surgery are also reviewed. The work concludes with a discussion of the rationale behind the next generation of continuous flow devices currently in human clinical trials.
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Affiliation(s)
- Marc E Stone
- Mount Sinai School of Medicine, New York, New York 10029-6574, USA.
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49
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Karimov JH, Sunagawa G, Horvath D, Fukamachi K, Starling RC, Moazami N. Limitations to Chronic Right Ventricular Assist Device Support. Ann Thorac Surg 2016; 102:651-8. [DOI: 10.1016/j.athoracsur.2016.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 01/20/2016] [Accepted: 02/01/2016] [Indexed: 12/16/2022]
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50
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Dandel M, Hetzer R. Echocardiographic assessment of the right ventricle: Impact of the distinctly load dependency of its size, geometry and performance. Int J Cardiol 2016; 221:1132-42. [PMID: 27474972 DOI: 10.1016/j.ijcard.2016.07.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/03/2016] [Indexed: 10/21/2022]
Abstract
Right ventricular (RV) size, shape and function are distinctly load-dependent and pulmonary load is an important determinant of RV function in patients with congestive heart failure (CHF) due to primary impaired left ventricular function and in those with pre-capillary pulmonary hypertension (PH). In a pressure overloaded RV, not only dilation and aggravation of tricuspid regurgitation, but also systolic dysfunction leading to RV failure (RVF) can occur already before the development of irreversible alterations in RV myocardial contractility. This explains RV ability for reverse remodeling and functional improvement in patients with post-capillary and pre-capillary PH of a different etiology, after normalization of loading conditions. There is increasing evidence that RV evaluation by echocardiography in relation with its loading conditions can improve the decision-making process and prognosis assessments in clinical praxis. Recent approaches to evaluate the RV in relation with its actual loading conditions by echo-derived composite variables which either incorporate a certain functional parameter (i.e. tricuspid annulus peak systolic excursion, stroke volume, RV end-systolic volume index, velocity of myocardial shortening) and load, or incorporate measures which reflect the relationship between RV load and RV dilation, also taking the right atrial pressure into account (i.e. "load adaptation index"), appeared particularly suited and therefore also potentially useful for evaluation of RV contractile function. Special attention is focused on the usefulness of RV echo-evaluation in relation to load for proper decision making before ventricular assist-device implantation in patients with CHF and for optimal timing of listing procedures to transplantation in patients with end-stage pre-capillary PH.
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Affiliation(s)
- Michael Dandel
- German Centre for Cardiovascular Research (DZHK), Partner site Berlin, Germany; Deutsches Herzzentrum Berlin, Germany.
| | - Roland Hetzer
- Deutsches Herzzentrum Berlin, Germany; Cardio Centrum Berlin, Germany
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