Document Detail

Predictors of severe right ventricular failure after implantable left ventricular assist device insertion: analysis of 245 patients.
MedLine Citation:
PMID:  12354733     Owner:  NLM     Status:  MEDLINE    
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.
Yoshie Ochiai; Patrick M McCarthy; Nicholas G Smedira; Michael K Banbury; Jose L Navia; Jingyuan Feng; Amy P Hsu; Michael L Yeager; Tiffany Buda; Katherine J Hoercher; Michael W Howard; Masami Takagaki; Kazuyoshi Doi; Kiyotaka Fukamachi
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Circulation     Volume:  106     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2002 Sep 
Date Detail:
Created Date:  2002-09-30     Completed Date:  2002-10-21     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  I198-202     Citation Subset:  AIM; IM    
Department of Biomedical Engineering, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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MeSH Terms
Heart Failure / diagnosis,  etiology*,  physiopathology
Heart-Assist Devices / adverse effects*
Middle Aged
Retrospective Studies
Risk Factors
Sex Factors
Ventricular Dysfunction, Right / diagnosis,  etiology*,  physiopathology

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