1
|
Beaulieu J, Vu C, Kalra S, Chahdi HO, Cousineau J, Matteau A, Mansour S, Jolicoeur EM, Jacques S, Nauche B, Podbielski R, Ferraro P, Poirier C, Potter BJ. Right Ventricular Assist Device with an Oxygenator for the Management of Combined Right Ventricular and Respiratory Failure: A Systematic Review. Can J Cardiol 2024:S0828-282X(24)00301-5. [PMID: 38604337 DOI: 10.1016/j.cjca.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Severe lung disease frequently presents with both refractory hypoxemia and right ventricular (RV) failure. OxyRVAD is an extra-corporeal membrane oxygenation (ECMO) configuration of RV bypass that also supplements gas exchange. This systematic review summarizes the available literature regarding the use of OxyRVAD in the setting of severe lung disease with associated RV failure. METHODS PubMed, Embase, and Google Scholar were queried on September 27th, 2023, for articles describing the use of an OxyRVAD configuration. The main outcome of interest was survival to ICU discharge. Data on the duration of OxyRVAD support and device-related complications were also recorded. RESULTS Of 475 identified articles, 33 were retained for analysis. Twenty-one articles were case reports and 12 were case series representing a total of 103 patients. No article provided a comparison group. Most patients (76.4%) were transitioned to OxyRVAD from another type of mechanical support. OxyRVAD was used as a bridge to transplant or curative surgery in 37.4% and as a bridge to recovery or decision in 62.6%. Thirty-one patients (30.1%) were managed with the dedicated single-access dual-lumen ProtekDuo cannula. Median time on OxyRVAD was twelve days (IQR 8-23) and survival to ICU discharge was 63.9%. Device-related complications were infrequently reported. CONCLUSION OxyRVAD support is a promising alternative for RV support when gas exchange is compromised with good ICU survival in selected cases. Comparative analyses in patients with RV failure with and without severe lung disease are needed.
Collapse
Affiliation(s)
| | - Christine Vu
- Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC
| | - Sanjog Kalra
- Interventional Cardiology, Department of Medicine, University Health Network (UHN), Toronto, ON
| | | | - Julie Cousineau
- Intensive Care Medicine, Department of Medicine, CHUM, Montréal, QC
| | - Alexis Matteau
- CHUM Research Center (CRHCUM), Montreal, QC; Interventional Cardiology, Department of Medicine, CHUM, Montréal, QC; Cardiac Intensive Care Unit, Department of Medicine, CHUM, Montréal, QC
| | - Samer Mansour
- CHUM Research Center (CRHCUM), Montreal, QC; Interventional Cardiology, Department of Medicine, CHUM, Montréal, QC; Cardiac Intensive Care Unit, Department of Medicine, CHUM, Montréal, QC
| | - E Marc Jolicoeur
- CHUM Research Center (CRHCUM), Montreal, QC; Interventional Cardiology, Department of Medicine, CHUM, Montréal, QC; Cardiac Intensive Care Unit, Department of Medicine, CHUM, Montréal, QC
| | | | - Bénédicte Nauche
- Bibliothèque du CHUM, Direction de l'enseignement et de l'Académie CHUM (DEAC), CHUM, Montréal, QC
| | - Renata Podbielski
- Bibliothèque du CHUM, Direction de l'enseignement et de l'Académie CHUM (DEAC), CHUM, Montréal, QC
| | - Pasquale Ferraro
- CHUM Research Center (CRHCUM), Montreal, QC; Thoracic Surgery, Department of Surgery, CHUM, Montréal, QC; Lung Transplant Program, CHUM, Montréal, QC
| | - Charles Poirier
- CHUM Research Center (CRHCUM), Montreal, QC; Lung Transplant Program, CHUM, Montréal, QC; Respirology, Department of Medicine, CHUM, Montréal, QC
| | - Brian J Potter
- CHUM Research Center (CRHCUM), Montreal, QC; Interventional Cardiology, Department of Medicine, CHUM, Montréal, QC; Cardiac Intensive Care Unit, Department of Medicine, CHUM, Montréal, QC.
| |
Collapse
|
2
|
Zeng X, Zhao R, Wu Z, Ma Z, Cen C, Gao S, Hong W, Yao Y, Wen K, Ding S, Wang J, Lu W, Wang X, Wang T. [ 18 F] -FAPI-42 PET/CT assessment of Progressive right ventricle fibrosis under pressure overload. Respir Res 2023; 24:270. [PMID: 37932744 PMCID: PMC10626814 DOI: 10.1186/s12931-023-02565-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/17/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Right heart failure (RHF) is a complication of pulmonary hypertension (PH) and increases the mortality independently of the underlying disease. However, the process of RHF development and progression is not fully understood. We aimed to develop effective approaches for early diagnosis and precise evaluation of RHF. METHODS Right ventricle (RV) pressure overload was performed via pulmonary artery banding (PAB) surgery in Sprague-Dawley (SD) rats to induce RHF. Echocardiography, right heart catheterization, histological staining, fibroblast activation protein (FAP) immunofluorescence and 18 F-labelled FAP inhibitor-42 ([18 F] -FAPI-42) positron emission tomography/computed tomography (PET/CT) were performed at day 3, week 1, 2, 4 and 8 after PAB. RNA sequencing was performed to explore molecular alterations between PAB and sham group at week 2 and week 4 after PAB respectively. RESULTS RV hemodynamic disorders were aggravated, and RV function was declined based on right heart catheterization and echocardiography at week 2, 4 and 8 after PAB. Progressive cardiac hypertrophy, fibrosis and capillary rarefaction could be observed in RV from 2 to 8 weeks after PAB. RNA sequencing indicated 80 upregulated genes and 43 downregulated genes in the RV at both week 2 and week 4 after PAB; Gene Ontology (GO) analysis revealed that fibrosis as the most significant biological process in the RV under pressure overload. Immunofluorescence indicated that FAP was upregulated in the RV from week 2 to week 8 after PAB; and [18 F] -FAPI-42 PET/CT revealed FAPI uptake was significantly higher in RV at week 2 and further increased at week 4 and 8 after PAB. CONCLUSION RV function is progressively declined with fibrosis as the most prominent molecular change after pressure overload, and [18 F] -FAPI-42 PET/CT is as sensitive and accurate as histopathology in RV fibrosis evaluation.
Collapse
Affiliation(s)
- Xiaohui Zeng
- State Key Laboratory of Respiratory Diseases, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ruiyue Zhao
- Department of Nuclear Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhixiong Wu
- State Key Laboratory of Respiratory Diseases, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhuoji Ma
- State Key Laboratory of Respiratory Diseases, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Chunxian Cen
- State Key Laboratory of Respiratory Diseases, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shanshan Gao
- State Key Laboratory of Respiratory Diseases, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wanxian Hong
- State Key Laboratory of Respiratory Diseases, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yanrong Yao
- Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Kexin Wen
- Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shangwei Ding
- Department of Ultrasound, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jian Wang
- State Key Laboratory of Respiratory Diseases, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wenju Lu
- State Key Laboratory of Respiratory Diseases, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xinlu Wang
- Department of Nuclear Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
| | - Tao Wang
- State Key Laboratory of Respiratory Diseases, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
| |
Collapse
|
3
|
Li B, Sun HS, Pan SW, Xu JP. Outcomes of Ebstein's Anomaly Patients Treated with Tricuspid Valvuloplasty or Tricuspid Valve Replacement: Experience of a Single Center. Chin Med J (Engl) 2018; 131:1067-1074. [PMID: 29692378 PMCID: PMC5937315 DOI: 10.4103/0366-6999.230731] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: The incidence of Ebstein's anomaly is extremely low, and except for the Mayo Clinic, no cardiac center has reported on a sufficient number of patients. The aim of our study was to report the outcomes of Ebstein's anomaly patients treated with tricuspid valvuloplasty (TVP) or tricuspid valve replacement (TVR). Methods: TVP or TVR was performed in 245 patients from July 2006 to April 2016. We reviewed patients' records and contacted patients via outpatient service and over the telephone. Results: The mean follow-up time was 43.6 ± 32.6 months, and 224 (91.4%) patients underwent follow-up. The mean operative age was 31.2 ± 15.7 years. TVR was performed in 23 patients, and TVP was performed in 201 patients. The 30-day mortality rate was 1.3%, and the overall survival rate was 97.9% at 5 and 10 years. The early mortality rate of the TVP group was lower than that of the TVR group (0.5% vs. 8.7%, P = 0.028), and the overall mortality rate of the TVP group was lower than that of the TVR group, without statistical significance (1.0% vs. 8.7%). After propensity score matching, the rates of mortality and New York Heart Association class ≥ III were lower in the TVP group than those in the TVR group without statistical significance. Seven patients with Type B Wolff-Parkinson-White (WPW) syndrome underwent one-stage surgery, and arrhythmias disappeared. Six patients suffered from episodes of left ventricular outflow tract obstruction (LVOTO) during surgery. Severe LVOTO could be treated with reoperation of the atrialized right ventricle. Conclusions: Ebstein's anomaly patients treated with TVP or TVR can experience optimal outcomes with midterm follow-up. However, TVP should be the first-choice treatment. Optimal outcomes can be obtained from one-stage operation in patients with Type B WPW syndrome. Severe LVOTO during surgery might be related to improper operation of the atrialized right ventricle.
Collapse
Affiliation(s)
- Bin Li
- Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
| | - Han-Song Sun
- Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
| | - Shi-Wei Pan
- Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
| | - Jian-Ping Xu
- Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
| |
Collapse
|