| Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: incidence, risk factors, and effect on outcomes. | |
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MedLine Citation:
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PMID: 20132950 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: The aim of this study was to evaluate the incidence, risk factors, and effect on outcomes of right ventricular failure in a large population of patients implanted with continuous-flow left ventricular assist devices. METHODS: Patients (n = 484) enrolled in the HeartMate II left ventricular assist device (Thoratec, Pleasanton, Calif) bridge-to-transplantation clinical trial were examined for the occurrence of right ventricular failure. Right ventricular failure was defined as requiring a right ventricular assist device, 14 or more days of inotropic support after implantation, and/or inotropic support starting more than 14 days after implantation. Demographics, along with clinical, laboratory, and hemodynamic data, were compared between patients with and without right ventricular failure, and risk factors were identified. RESULTS: Overall, 30 (6%) patients receiving left ventricular assist devices required a right ventricular assist device, 35 (7%) required extended inotropes, and 33 (7%) required late inotropes. A significantly greater percentage of patients without right ventricular failure survived to transplantation, recovery, or ongoing device support at 180 days compared with patients with right ventricular failure (89% vs 71%, P < .001). Multivariate analysis revealed that a central venous pressure/pulmonary capillary wedge pressure ratio of greater than 0.63 (odds ratio, 2.3; 95% confidence interval, 1.2-4.3; P = .009), need for preoperative ventilator support (odds ratio, 5.5; 95% confidence interval, 2.3-13.2; P < .001), and blood urea nitrogen level of greater than 39 mg/dL (odds ratio, 2.1; 95% confidence interval, 1.1-4.1; P = .02) were independent predictors of right ventricular failure after left ventricular assist device implantation. CONCLUSIONS: The incidence of right ventricular failure in patients with a HeartMate II ventricular assist device is comparable or less than that of patients with pulsatile-flow devices. Its occurrence is associated with worse outcomes than seen in patients without right ventricular failure. Patients at risk for right ventricular failure might benefit from preoperative optimization of right heart function or planned biventricular support. |
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Authors:
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Robert L Kormos; Jeffrey J Teuteberg; Francis D Pagani; Stuart D Russell; Ranjit John; Leslie W Miller; Todd Massey; Carmelo A Milano; Nader Moazami; Kartik S Sundareswaran; David J Farrar; |
Publication Detail:
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Type: Journal Article; Multicenter Study Date: 2010-02-04 |
Journal Detail:
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Title: The Journal of thoracic and cardiovascular surgery Volume: 139 ISSN: 1097-685X ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2010 May |
Date Detail:
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Created Date: 2010-04-23 Completed Date: 2010-05-06 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1316-24 Citation Subset: AIM; IM |
Copyright Information:
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2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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Heart, Lung & Esophageal Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. kormosrl@upmc.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Blood Urea Nitrogen Cardiotonic Agents / therapeutic use* Central Venous Pressure Chi-Square Distribution Clinical Trials as Topic Female Heart Failure / complications, mortality, physiopathology, therapy* Heart-Assist Devices / adverse effects* Humans Incidence Kaplan-Meiers Estimate Logistic Models Male Middle Aged Multicenter Studies as Topic Odds Ratio Pulmonary Wedge Pressure Respiration, Artificial / adverse effects Retrospective Studies Risk Assessment Risk Factors Time Factors Treatment Outcome United States / epidemiology Ventricular Dysfunction, Left / complications, mortality, physiopathology, therapy* Ventricular Dysfunction, Right / etiology*, mortality, physiopathology, therapy |
| Chemical | |
Reg. No./Substance:
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0/Cardiotonic Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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