| Predictors of severe right ventricular failure after implantable left ventricular assist device insertion: analysis of 245 patients. | |
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MedLine Citation:
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PMID: 12354733 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: Circulation Volume: 106 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2002 Sep |
Date Detail:
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Created Date: 2002-09-30 Completed Date: 2002-10-21 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: I198-202 Citation Subset: AIM; IM |
Affiliation:
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Department of Biomedical Engineering, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Female Heart Failure / diagnosis, etiology*, physiopathology Heart-Assist Devices / adverse effects* Hemodynamics Humans Male Middle Aged Prognosis Retrospective Studies Risk Factors Sex Factors Ventricular Dysfunction, Right / diagnosis, etiology*, physiopathology |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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