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Predictors of severe right ventricular failure after implantable left ventricular assist device insertion: analysis of 245 patients.
Circulation. 2002 Sep 24; 106(12 Suppl 1):I198-202.Circ

Abstract

BACKGROUND

Insertion of an implantable left ventricular assist device (LVAD) complicated by early right ventricular (RV) failure has a poor prognosis and is largely unpredictable. Prediction of RV failure after LVAD placement would lead to more precise patient selection and optimal device selection.

METHODS AND RESULTS

We reviewed data from 245 patients (mean age, 54+/-11 years; 85% male) with 189 HeartMate (77%) and 56 Novacor (23%) LVADs. Ischemic cardiomyopathy predominated (65%), and 29% had dilated cardiomyopathy. Overall, RV assist device (RVAD) support was required after LVAD insertion for 23 patients (9%). We compared clinical and hemodynamic parameters before LVAD insertion between RVAD (n=23) and No-RVAD patients (n=222) to determine preoperative risk factors for severe RV failure. By univariate analysis, female gender, small body surface area, nonischemic etiology, preoperative mechanical ventilation, circulatory support before LVAD insertion, low mean and diastolic pulmonary artery pressures (PAPs), low RV stroke work (RVSW), and low RVSW index (RVSWI) were significantly associated with RVAD use. Elevated PAP and pulmonary vascular resistance were not risk factors. Risk factors by multivariable logistic regression were preoperative circulatory support (odds ratio [OR], 5.3), female gender (OR, 4.5), and nonischemic etiology (OR, 3.3).

CONCLUSIONS

The need for circulatory support, female gender, and nonischemic etiology were the most significant predictors for RVAD use after LVAD insertion. Regarding hemodynamics, low PAP and low RVSWI, reflecting low RV contractility, were important parameters. This information may lead to better patient selection for isolated LVAD implantation.

Authors+Show Affiliations

Ochiai Y
Department of Biomedical Engineering, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
McCarthy PM
No affiliation info available
Smedira NG
No affiliation info available
Banbury MK
No affiliation info available
Navia JL
No affiliation info available
Feng J
No affiliation info available
Hsu AP
No affiliation info available
Yeager ML
No affiliation info available
Buda T
No affiliation info available
Hoercher KJ
No affiliation info available
Howard MW
No affiliation info available
Takagaki M
No affiliation info available
Doi K
No affiliation info available
Fukamachi K
No affiliation info available

MeSH

AdolescentAdultAgedFemaleHeart FailureHeart-Assist DevicesHemodynamicsHumansMaleMiddle AgedPrognosisRetrospective StudiesRisk FactorsSex FactorsVentricular Dysfunction, Right

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

12354733

Citation

Ochiai, Yoshie, et al. "Predictors of Severe Right Ventricular Failure After Implantable Left Ventricular Assist Device Insertion: Analysis of 245 Patients." Circulation, vol. 106, no. 12 Suppl 1, 2002, pp. I198-202.
Ochiai Y, McCarthy PM, Smedira NG, et al. Predictors of severe right ventricular failure after implantable left ventricular assist device insertion: analysis of 245 patients. Circulation. 2002;106(12 Suppl 1):I198-202.
Ochiai, Y., McCarthy, P. M., Smedira, N. G., Banbury, M. K., Navia, J. L., Feng, J., Hsu, A. P., Yeager, M. L., Buda, T., Hoercher, K. J., Howard, M. W., Takagaki, M., Doi, K., & Fukamachi, K. (2002). Predictors of severe right ventricular failure after implantable left ventricular assist device insertion: analysis of 245 patients. Circulation, 106(12 Suppl 1), I198-202.
Ochiai Y, et al. Predictors of Severe Right Ventricular Failure After Implantable Left Ventricular Assist Device Insertion: Analysis of 245 Patients. Circulation. 2002 Sep 24;106(12 Suppl 1):I198-202. PubMed PMID: 12354733.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of severe right ventricular failure after implantable left ventricular assist device insertion: analysis of 245 patients. AU - Ochiai,Yoshie, AU - McCarthy,Patrick M, AU - Smedira,Nicholas G, AU - Banbury,Michael K, AU - Navia,Jose L, AU - Feng,Jingyuan, AU - Hsu,Amy P, AU - Yeager,Michael L, AU - Buda,Tiffany, AU - Hoercher,Katherine J, AU - Howard,Michael W, AU - Takagaki,Masami, AU - Doi,Kazuyoshi, AU - Fukamachi,Kiyotaka, PY - 2002/10/2/pubmed PY - 2002/10/22/medline PY - 2002/10/2/entrez SP - I198 EP - 202 JF - Circulation JO - Circulation VL - 106 IS - 12 Suppl 1 N2 - BACKGROUND: Insertion of an implantable left ventricular assist device (LVAD) complicated by early right ventricular (RV) failure has a poor prognosis and is largely unpredictable. Prediction of RV failure after LVAD placement would lead to more precise patient selection and optimal device selection. METHODS AND RESULTS: We reviewed data from 245 patients (mean age, 54+/-11 years; 85% male) with 189 HeartMate (77%) and 56 Novacor (23%) LVADs. Ischemic cardiomyopathy predominated (65%), and 29% had dilated cardiomyopathy. Overall, RV assist device (RVAD) support was required after LVAD insertion for 23 patients (9%). We compared clinical and hemodynamic parameters before LVAD insertion between RVAD (n=23) and No-RVAD patients (n=222) to determine preoperative risk factors for severe RV failure. By univariate analysis, female gender, small body surface area, nonischemic etiology, preoperative mechanical ventilation, circulatory support before LVAD insertion, low mean and diastolic pulmonary artery pressures (PAPs), low RV stroke work (RVSW), and low RVSW index (RVSWI) were significantly associated with RVAD use. Elevated PAP and pulmonary vascular resistance were not risk factors. Risk factors by multivariable logistic regression were preoperative circulatory support (odds ratio [OR], 5.3), female gender (OR, 4.5), and nonischemic etiology (OR, 3.3). CONCLUSIONS: The need for circulatory support, female gender, and nonischemic etiology were the most significant predictors for RVAD use after LVAD insertion. Regarding hemodynamics, low PAP and low RVSWI, reflecting low RV contractility, were important parameters. This information may lead to better patient selection for isolated LVAD implantation. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/12354733/Predictors_of_severe_right_ventricular_failure_after_implantable_left_ventricular_assist_device_insertion:_analysis_of_245_patients_ DB - PRIME DP - Unbound Medicine ER -