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Barros LN, Uchoa RB, Mejia JAC, Nunes RR, Barros DASN, Rodrigues Filho F. Anesthetic protocol for right ventricular dysfunction management in heart transplantation: systematic review, development and validation. BMC Anesthesiol 2021; 21:46. [PMID: 33573599 PMCID: PMC7877082 DOI: 10.1186/s12871-021-01261-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Right Ventricular Dysfunction (RVD) is the most frequent intraoperative hemodynamic complication in Heart Transplantation (HTx). RVD occurs in 0.04-1.0% of cardiac surgeries with cardiotomy and in 20-50% of HTx, with mortality up to 75%. No consensus has been established for how anesthesiologists should manage RVD, with management methods many times remaining unvalidated. METHODS We conducted a systematic review, following PRISMA guidelines, to create an anesthetic protocol to manage RVD in HTx, using databases that include PubMed and Embase, until September 2018 based on inclusion and exclusion criteria. The articles screening for the systematic review were done two independent reviewers, in case of discrepancy, we consulted a third independent reviewer. Based on the systematic review, the anesthetic protocol was developed. The instrument selected to perform the validation of the protocol was AGREE II, for this purpose expert anesthetists were recruited to do this process. The minimum arbitration score for domains validation cutoff of AGREE II is arbitered to 70%. This study was registered at PROSPERO (115600). RESULTS In the systematic review, 152 articles were included. We present the protocol in a flowchart with six steps based on goal-directed therapy, invasive monitoring, and transesophageal echocardiogram. Six experts judged the protocol and validated it. CONCLUSION The protocol has been validated by experts and new studies are needed to assess its applicability and potential benefits on major endpoints.
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Affiliation(s)
- Lucas Nepomuceno Barros
- State University of Ceará, Fortaleza, Brazil. .,Dr Carlos Alberto Studart Gomes - Messejana Hospital, Fortaleza, Brazil. .,Fortaleza General Hospital, Fortaleza, Brazil.
| | | | - Juan Alberto Cosquillo Mejia
- State University of Ceará, Fortaleza, Brazil.,Dr Carlos Alberto Studart Gomes - Messejana Hospital, Fortaleza, Brazil
| | | | | | - Filadelfo Rodrigues Filho
- State University of Ceará, Fortaleza, Brazil.,Dr Carlos Alberto Studart Gomes - Messejana Hospital, Fortaleza, Brazil.,Professor in Professional Master's in Transplants, State University of Ceará, Fortaleza, Brazil
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Kapa S, Vaidya V, Hodge DO, McLeod CJ, Connolly HM, Warnes CA, Asirvatham SJ. Right ventricular dysfunction in congenitally corrected transposition of the great arteries and risk of ventricular tachyarrhythmia and sudden death. Int J Cardiol 2018; 258:83-89. [DOI: 10.1016/j.ijcard.2018.01.107] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/06/2018] [Accepted: 01/22/2018] [Indexed: 11/25/2022]
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Soliman OI, Akin S, Muslem R, Boersma E, Manintveld OC, Krabatsch T, Gummert JF, de By TM, Bogers AJ, Zijlstra F, Mohacsi P, Caliskan K. Derivation and Validation of a Novel Right-Sided Heart Failure Model After Implantation of Continuous Flow Left Ventricular Assist Devices. Circulation 2018; 137:891-906. [DOI: 10.1161/circulationaha.117.030543] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 08/15/2017] [Indexed: 12/21/2022]
Abstract
Background:
The aim of the study was to derive and validate a novel risk score for early right-sided heart failure (RHF) after left ventricular assist device implantation.
Methods:
The EUROMACS (European Registry for Patients with Mechanical Circulatory Support) was used to identify adult patients undergoing continuous-flow left ventricular assist device implantation with mainstream devices. Eligible patients (n=2988) were randomly divided into derivation (n=2000) and validation (n=988) cohorts. The primary outcome was early (<30 days) severe postoperative RHF, defined as receiving short- or long-term right-sided circulatory support, continuous inotropic support for ≥14 days, or nitric oxide ventilation for ≥48 hours. The secondary outcome was all-cause mortality and length of stay in the intensive care unit. Covariates found to be associated with RHF (exploratory univariate
P
<0.10) were entered into a multivariable logistic regression model. A risk score was then generated using the relative magnitude of the exponential regression model coefficients of independent predictors at the last step after checking for collinearity, likelihood ratio test, c index, and clinical weight at each step.
Results:
A 9.5-point risk score incorporating 5 variables (Interagency Registry for Mechanically Assisted Circulatory Support class, use of multiple inotropes, severe right ventricular dysfunction on echocardiography, ratio of right atrial/pulmonary capillary wedge pressure, hemoglobin) was created. The mean scores in the derivation and validation cohorts were 2.7±1.9 and 2.6±2.0, respectively (
P
=0.32). RHF in the derivation cohort occurred in 433 patients (21.7%) after left ventricular assist device implantation and was associated with a lower 1-year (53% versus 71%;
P
<0.001) and 2-year (45% versus 58%;
P
<0.001) survival compared with patients without RHF. RHF risk ranged from 11% (low risk score 0–2) to 43.1% (high risk score >4;
P
<0.0001). Median intensive care unit stay was 7 days (interquartile range, 4–15 days) versus 24 days (interquartile range, 14–38 days) in patients without versus with RHF, respectively (
P
<0.001). The c index of the composite score was 0.70 in the derivation and 0.67 in the validation cohort. The EUROMACS-RHF risk score outperformed (
P
<0.0001) previously published scores and known individual echocardiographic and hemodynamic markers of RHF.
Conclusions:
This novel EUROMACS-RHF risk score outperformed currently known risk scores and clinical predictors of early postoperative RHF. This novel score may be useful for tailored risk-based clinical assessment and management of patients with advanced HF evaluated for ventricular assist device therapy.
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Affiliation(s)
- Osama I.I. Soliman
- Department of Cardiology, Thoraxcenter (O.I.I.S., S.A., R.M., E.B., O.C.M., F.Z., K.C.)
| | - Sakir Akin
- Department of Cardiology, Thoraxcenter (O.I.I.S., S.A., R.M., E.B., O.C.M., F.Z., K.C.)
- Intensive Care (S.A.)
| | - Rahatullah Muslem
- Department of Cardiology, Thoraxcenter (O.I.I.S., S.A., R.M., E.B., O.C.M., F.Z., K.C.)
- Cardiothoracic Surgery (R.M., A.J.J.C.B.)
| | - Eric Boersma
- Department of Cardiology, Thoraxcenter (O.I.I.S., S.A., R.M., E.B., O.C.M., F.Z., K.C.)
| | - Olivier C. Manintveld
- Department of Cardiology, Thoraxcenter (O.I.I.S., S.A., R.M., E.B., O.C.M., F.Z., K.C.)
| | - Thomas Krabatsch
- Erasmus Medical Center, University Medical Centre Rotterdam, the Netherlands. Department of Cardiac Surgery, German Heart Centre Berlin, Germany (T.K.)
| | - Jan F. Gummert
- Department for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany (J.F.G.)
| | | | | | - Felix Zijlstra
- Department of Cardiology, Thoraxcenter (O.I.I.S., S.A., R.M., E.B., O.C.M., F.Z., K.C.)
| | - Paul Mohacsi
- Department of Cardiology, University Hospital Bern, University of Bern, Switzerland (P.M.)
| | - Kadir Caliskan
- Department of Cardiology, Thoraxcenter (O.I.I.S., S.A., R.M., E.B., O.C.M., F.Z., K.C.)
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Haraldsen P, Metzsch C, Lindstedt S, Algotsson L, Ingemansson R. Sevoflurane anesthesia during acute right ventricular ischemia in pigs preserves cardiac function better than propofol anesthesia. Perfusion 2016; 31:495-502. [PMID: 26960337 DOI: 10.1177/0267659116637134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The intention of the present study was to evaluate possible cardioprotective properties of inhalation anesthesia with sevoflurane. METHODS AND MATERIALS A porcine, open-chest model of right ventricular ischemia was used in 7 pigs receiving inhalation anesthesia with sevoflurane. The model was earlier developed and published by our group, using pigs receiving intravenous anesthesia with propofol. They served as controls. The animals were observed for three hours after the induction of right ventricular ischemia by ligation of the main branches supplying the right ventricular free wall. RESULTS In the sevoflurane group, the cardiac output recovered 2 hours after the induction of ischemia and intact right ventricular stroke work was observed. In the propofol group, no such recovery occurred. The release of troponin T was significantly lower than in the sevoflurane group. CONCLUSIONS Inhalation anesthesia with sevoflurane seems superior to intravenous anesthesia with propofol in acute right ventricular ischemic dysfunction.
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Affiliation(s)
- Pernille Haraldsen
- Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Skane University Hospital, Lund, Sweden
| | - Carsten Metzsch
- Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Skane University Hospital, Lund, Sweden
| | - Sandra Lindstedt
- Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Skane University Hospital, Lund, Sweden
| | - Lars Algotsson
- Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Skane University Hospital, Lund, Sweden
| | - Richard Ingemansson
- Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Skane University Hospital, Lund, Sweden
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5
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Kuznetsov VA, Yaroslavskaya EI, Pushkarev GS, Krinochkin DV, Bessonov IS, Gorbatenko EA. [Right ventricular dilatation in patients with coronary heart disease without myocardial infarction: According to the data of the Coronary Angiography Surgery Registry]. TERAPEVT ARKH 2016; 87:34-38. [PMID: 26591550 DOI: 10.17116/terarkh201587934-38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To identify factors associated with right ventricular (RV) dilatation in patients with coronary heart disease (CHD) without prior myocardial infarction (Ml). SUBJECTS AND METHODS Out of 16 839 patents from the Coronary Angiography Surgery Registry, the investigators selected patients with >75% stenosis in at least one coronary artery without acute or prior MI: 75 patients with echocardiographically detected RV dilatation and 1134 without RV dilatation. RESULTS Among the patients with RV dilatation, there were more men (92% versus 80.2%; p=0.01 2). In this group, the mean body mass index (BMI) was higher (31.7±5.2 kg/m2 versus 30.1±4.7 kg/m2; p=0.01 9); there was more commonly higher NYHA functional class (FC) (III) chronic heart failure (CHF) (22.2% versus 12.5%; p=0.002), clinically relevant mitral regurgitation (29.4% versus 4.0%; all ps<0.001), and cardiac rhythm and conduction disturbances (45.5% versus 17.8%; p<0.001) in rarer severe FC (III-IV) exertional angina (30.3% versus 52.8%; p=0.007). The groups were different as evidenced by coronarography and major blood biochemical indicators. Decreased myocardial contractility (odds ratio (OR), 4.22; p=0.002), male sex (OR, 4.03;p=0.007), cardiac rhythm and conduction disturbances (OR, 2.98; p<0.001), clinically relevant mitral regurgitation (OR, 2.34; p=0.001); higher FC CHF (OR, 1.87; p=0.034), BMI (OR, 1.08; p=0.01 0), and lower FC exertional angina (OR, 0.42; p=0.001) demonstrated an independent relationship to RV dilatation, as evidenced by a multivariateanalysis. CONCLUSION In the patients with CHD without MI, RV dilatation is independently related to male sex, left ventricular functional characteristics, and higher BMI.
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Affiliation(s)
- V A Kuznetsov
- Research Department of Instrumental Studies, Tyumen Cardiology Center, Branch, Research Institute of Cardiology, Siberian Branch, Russian Academy of Medical Sciences, Tyumen, Russia
| | - E I Yaroslavskaya
- Research Department of Instrumental Studies, Tyumen Cardiology Center, Branch, Research Institute of Cardiology, Siberian Branch, Russian Academy of Medical Sciences, Tyumen, Russia
| | - G S Pushkarev
- Research Department of Instrumental Studies, Tyumen Cardiology Center, Branch, Research Institute of Cardiology, Siberian Branch, Russian Academy of Medical Sciences, Tyumen, Russia
| | - D V Krinochkin
- Research Department of Instrumental Studies, Tyumen Cardiology Center, Branch, Research Institute of Cardiology, Siberian Branch, Russian Academy of Medical Sciences, Tyumen, Russia
| | - I S Bessonov
- Research Department of Instrumental Studies, Tyumen Cardiology Center, Branch, Research Institute of Cardiology, Siberian Branch, Russian Academy of Medical Sciences, Tyumen, Russia
| | - E A Gorbatenko
- Research Department of Instrumental Studies, Tyumen Cardiology Center, Branch, Research Institute of Cardiology, Siberian Branch, Russian Academy of Medical Sciences, Tyumen, Russia
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6
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King C, May CW, Williams J, Shlobin OA. Management of right heart failure in the critically ill. Crit Care Clin 2015; 30:475-98. [PMID: 24996606 DOI: 10.1016/j.ccc.2014.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Right ventricular failure complicates several commonly encountered conditions in the intensive care unit. Right ventricular dilation and paradoxic movement of the interventricular septum on echocardiography establishes the diagnosis. Right heart catheterization is useful in establishing the specific cause and aids clinicians in management. Principles of treatment focus on reversal of the underlying cause, optimization of right ventricular preload and contractility, and reduction of right ventricular afterload. Mechanical support with right ventricular assist device or veno-arterial extracorporeal membrane oxygenation can be used in select patients who fail to improve with optimal medical therapy.
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Affiliation(s)
- Christopher King
- Medical Critical Care Service, Inova Fairfax Hospital, 618 South Royal Street, Alexandria, VA 22314, USA.
| | - Christopher W May
- Advanced Heart Failure and Cardiac Transplant Program, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Jeffrey Williams
- Medical Critical Care Service, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Oksana A Shlobin
- Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA
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7
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Kiernan MS, French AL, DeNofrio D, Parmar YJ, Pham DT, Kapur NK, Pandian NG, Patel AR. Preoperative Three-Dimensional Echocardiography to Assess Risk of Right Ventricular Failure After Left Ventricular Assist Device Surgery. J Card Fail 2015; 21:189-97. [DOI: 10.1016/j.cardfail.2014.12.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 11/21/2014] [Accepted: 12/16/2014] [Indexed: 12/31/2022]
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8
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Gulati A, Ismail TF, Jabbour A, Alpendurada F, Guha K, Ismail NA, Raza S, Khwaja J, Brown TDH, Morarji K, Liodakis E, Roughton M, Wage R, Pakrashi TC, Sharma R, Carpenter JP, Cook SA, Cowie MR, Assomull RG, Pennell DJ, Prasad SK. The prevalence and prognostic significance of right ventricular systolic dysfunction in nonischemic dilated cardiomyopathy. Circulation 2013; 128:1623-33. [PMID: 23965488 DOI: 10.1161/circulationaha.113.002518] [Citation(s) in RCA: 234] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cardiovascular magnetic resonance is the gold-standard technique for the assessment of ventricular function. Although left ventricular volumes and ejection fraction are strong predictors of outcome in dilated cardiomyopathy (DCM), there are limited data regarding the prognostic significance of right ventricular (RV) systolic dysfunction (RVSD). We investigated whether cardiovascular magnetic resonance assessment of RV function has prognostic value in DCM. METHODS AND RESULTS We prospectively studied 250 consecutive DCM patients with the use of cardiovascular magnetic resonance. RVSD, defined by RV ejection fraction≤45%, was present in 86 (34%) patients. During a median follow-up period of 6.8 years, there were 52 deaths, and 7 patients underwent cardiac transplantation. The primary end point of all-cause mortality or cardiac transplantation was reached by 42 of 86 patients with RVSD and 17 of 164 patients without RVSD (49% versus 10%; hazard ratio, 5.90; 95% confidence interval [CI], 3.35-10.37; P<0.001). On multivariable analysis, RVSD remained a significant independent predictor of the primary end point (hazard ratio, 3.90; 95% CI, 2.16-7.04; P<0.001), as well as secondary outcomes of cardiovascular mortality or cardiac transplantation (hazard ratio, 3.35; 95% CI, 1.76-6.39; P<0.001), and heart failure death, heart failure hospitalization, or cardiac transplantation (hazard ratio, 2.70; 95% CI, 1.32-5.51; P=0.006). Assessment of RVSD improved risk stratification for all-cause mortality or cardiac transplantation (net reclassification improvement, 0.31; 95% CI 0.10-0.53; P=0.001). CONCLUSIONS RVSD is a powerful, independent predictor of transplant-free survival and adverse heart failure outcomes in DCM. Cardiovascular magnetic resonance assessment of RV function is important in the evaluation and risk stratification of DCM patients.
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Affiliation(s)
- Ankur Gulati
- Royal Brompton Hospital, London, United Kingdom (A.G., T.F.I., A.J., F.A., K.G., N.A.I., S.R., J.K., T.D.H.B., K.M., E.L., M.R., R.W., T.C.P., R.S., J.-P.C., S.A.C., M.R.C., R.G.A., D.J.P., S.K.P.); Ealing Hospital, London, United Kingdom (R.G.A.); National Heart & Lung Institute, Imperial College, London, United Kingdom (T.F.I., K.G., R.S., J.-.P.C., S.A.C., M.R.C., D.J.P., S.K.P.); and National Heart Centre Singapore, Singapore (S.A.C.)
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9
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Rabinovitz A, Raiszadeh F, Zolty R. Association of Hyponatremia and Outcomes in Pulmonary Hypertension. J Card Fail 2013; 19:550-6. [DOI: 10.1016/j.cardfail.2013.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 05/21/2013] [Accepted: 05/22/2013] [Indexed: 11/28/2022]
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Affiliation(s)
- Marco Guazzi
- Heart Failure Unit, Cardiology, I.R.C.C.S., Policlinico San Donato, Department of Medical Sciences, University of Milano, Piazza Malan 1 20097, San Donato Milanese, Milano, Italy.
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Lumens J, Arts T, Marcus JT, Vonk-Noordegraaf A, Delhaas T. Early-diastolic left ventricular lengthening implies pulmonary hypertension-induced right ventricular decompensation. Cardiovasc Res 2012; 96:286-95. [DOI: 10.1093/cvr/cvs251] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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12
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Current Role of Imaging in the Diagnosis and Management of Pulmonary Hypertension. AJR Am J Roentgenol 2012; 198:1320-31. [DOI: 10.2214/ajr.11.7366] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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13
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Trochu JN, Leprince P, Bielefeld-Gomez M, Bastien O, Beauvais F, Gueffet JP, Logeart D, Isnard R, Iliou MC, Leclercq C, Girard C. Left ventricle assist device: when and which patients should we refer? Arch Cardiovasc Dis 2012; 105:114-21. [PMID: 22424329 DOI: 10.1016/j.acvd.2011.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 11/06/2011] [Accepted: 11/08/2011] [Indexed: 11/17/2022]
Abstract
Progress in the medical treatment of patients with heart failure with systolic dysfunction, cardiac resynchronization therapy, internal cardiac defibrillators and multidisciplinary management programmes has resulted in dramatic improvements in survival and quality of life; however, this progress has led to an increase in the prevalence of advanced heart failure. In the context of organ shortage for cardiac transplantation, the technological developments in left ventricular assist devices, shown in recent positive clinical studies, provide real hope for patients with advanced heart failure. This article summarizes the most recent clinical studies concerning left ventricular assist devices and discusses for whom and when a left ventricular assist device should be proposed.
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Affiliation(s)
- Jean-Noël Trochu
- Inserm, UMR, université de Nantes, l'institut du thorax, CHU de Nantes, France.
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Kalogeropoulos AP, Vega JD, Smith AL, Georgiopoulou VV. Pulmonary Hypertension and Right Ventricular Function in Advanced Heart Failure. ACTA ACUST UNITED AC 2011; 17:189-98. [DOI: 10.1111/j.1751-7133.2011.00234.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mau J, Menzie S, Huang Y, Ward M, Hunyor S. Nonsurround, nonuniform, biventricular-capable direct cardiac compression provides Frank-Starling recruitment independent of left ventricular septal damage. J Thorac Cardiovasc Surg 2011; 142:209-15. [DOI: 10.1016/j.jtcvs.2010.05.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2009] [Revised: 04/14/2010] [Accepted: 05/06/2010] [Indexed: 12/31/2022]
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Simon MA, Pinsky MR. Right ventricular dysfunction and failure in chronic pressure overload. Cardiol Res Pract 2011; 2011:568095. [PMID: 21559218 PMCID: PMC3087982 DOI: 10.4061/2011/568095] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 01/25/2011] [Indexed: 11/20/2022] Open
Abstract
Right ventricular (RV) dysfunction is the main cause of death in pulmonary arterial hypertension (PAH). Our understanding of the pathophysiology of RV dysfunction is limited but improving. Methods to better diagnose RV dysfunction earlier and treatments specifically designed to minimize or reverse the remodeling process are likely to improve outcomes. We review the current understanding of RV dysfunction in chronic pressure overload and introduce some novel insights based on recent investigations into pathophysiology, diagnosis, and treatment.
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Affiliation(s)
- Marc A Simon
- Cardiovascular Institute, University of Pittsburgh, Scaife Hall S-554, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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17
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Utility of transthoracic echocardiography to estimate severity of right ventricular dysfunction: an MRI comparison study. Int J Cardiovasc Imaging 2011; 28:251-61. [DOI: 10.1007/s10554-011-9810-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 01/13/2011] [Indexed: 10/18/2022]
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Guglielmini C, Civitella C, Diana A, Di Tommaso M, Cipone M, Luciani A. Serum cardiac troponin I concentration in dogs with precapillary and postcapillary pulmonary hypertension. J Vet Intern Med 2010; 24:145-52. [PMID: 20002552 DOI: 10.1111/j.1939-1676.2009.0430.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is a disease condition leading to right-sided cardiac hypertrophy and, eventually, right-sided heart failure. Cardiac troponin I (cTnI) is a circulating biomarker of cardiac damage. HYPOTHESIS Myocardial damage can occur in dogs with precapillary and postcapillary PH. ANIMALS One hundred and thirty-three dogs were examined: 26 healthy controls, 42 dogs with mitral valve disease (MVD) without PH, 48 dogs with pulmonary hypertension associated with mitral valve disease (PH-MVD), and 17 dogs with precapillary PH. METHODS Prospective, observational study. Serum cTnI concentration was measured with a commercially available immunoassay and results were compared between groups. RESULTS Median cTnI was 0.10 ng/mL (range 0.10-0.17 ng/mL) in healthy dogs. Compared with the healthy population, median serum cTnI concentration was increased in dogs with precapillary PH (0.25 ng/mL; range 0.10-1.9 ng/mL; P < .001) and in dogs with PH-MVD (0.21 ng/mL; range 0.10-2.10 ng/mL; P < .001). Median serum cTnI concentration of dogs with MVD (0.12 ng/mL; range 0.10-1.00 ng/mL) was not significantly different compared with control group and dogs with PH-MVD. In dogs with MVD and PH-MVD, only the subgroup with decompensated PH-MVD had significantly higher cTnI concentration compared with dogs with compensated MVD and PH-MVD. Serum cTnI concentration showed significant modest positive correlations with the calculated pulmonary artery systolic pressure in dogs with PH and some echocardiographic indices in dogs with MVD and PH-MVD. CONCLUSIONS AND CLINICAL IMPORTANCE Serum cTnI is high in dogs with either precapillary and postcapillary PH. Myocardial damage in dogs with postcapillary PH is likely the consequence of increased severity of MVD.
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Affiliation(s)
- C Guglielmini
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, University of Teramo, Teramo, Italy.
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20
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Yerebakan C, Klopsch C, Niefeldt S, Zeisig V, Vollmar B, Liebold A, Sandica E, Steinhoff G. Acute and chronic response of the right ventricle to surgically induced pressure and volume overload – an analysis of pressure–volume relations☆. Interact Cardiovasc Thorac Surg 2010; 10:519-25. [DOI: 10.1510/icvts.2009.221234] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Bhavsar SS, Kapadia JY, Chopski SG, Throckmorton AL. Intravascular mechanical cavopulmonary assistance for patients with failing Fontan physiology. Artif Organs 2010; 33:977-87. [PMID: 20021471 DOI: 10.1111/j.1525-1594.2009.00940.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To provide a viable bridge-to-transplant, bridge-to-recovery, or bridge-to-surgical reconstruction for patients with failing Fontan physiology, we are developing a collapsible, percutaneously inserted, magnetically levitated axial flow blood pump to support the cavopulmonary circulation in adolescent and adult patients. This unique blood pump will augment pressure and thus flow in the inferior vena cava through the lungs and ameliorate the poor hemodynamics associated with the univentricular circulation. Computational fluid dynamics analyses were performed to create the design of the impeller, the protective cage of filaments, and the set of diffuser blades for our axial flow blood pump. These analyses included the generation of pressure-flow characteristics, scalar stress estimations, and blood damage indexes. A quasi-steady analysis of the diffuser rotation was also completed and indicated an optimal diffuser rotational orientation of approximately 12 degrees. The numerical predictions of the pump performance demonstrated a pressure generation of 2-25 mm Hg for 1-7 L/min over 3000-8000 rpm. Scalar stress values were less than 200 Pa, and fluid residence times were found to be within acceptable ranges being less than 0.25 s. The maximum blood damage index was calculated to be 0.068%. These results support the continued design and development of this cavopulmonary assist device, building upon previous numerical work and experimental prototype testing.
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Affiliation(s)
- Sonya S Bhavsar
- Department of Mechanical Engineering, Virginia Commonwealth University, Richmond, VA 23284, USA
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