Document Detail


Risk score derived from pre-operative data analysis predicts the need for biventricular mechanical circulatory support.
MedLine Citation:
PMID:  19059108     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Right ventricular (RV) failure after left ventricular assist device (LVAD) placement is a serious complication and is difficult to predict. In the era of destination therapy and the total artificial heart, predicting post-LVAD RV failure requiring mechanical support is extremely important.
METHODS: We reviewed patient characteristics, laboratory values and hemodynamic data from 266 patients who underwent LVAD placement at the University of Pennsylvania from April 1995 to June 2007.
RESULTS: Of 266 LVAD recipients, 99 required RV assist device (BiVAD) placement (37%). We compared 36 parameters between LVAD (n = 167) and BiVAD patients (n = 99) to determine pre-operative risk factors for RV assist device (RVAD) need. By univariate analysis, 23 variables showed statistically significant differences between the two groups (p < or = 0.05). By multivariate logistic regression, cardiac index < or =2.2 liters/min/m(2) (odds ratio [OR] 5.7), RV stroke work index < or =0.25 mm Hg . liter/m(2) (OR 5.1), severe pre-operative RV dysfunction (OR 5.0), pre-operative creatinine > or =1.9 mg/dl (OR 4.8), previous cardiac surgery (OR 4.5) and systolic blood pressure < or =96 mm Hg (OR 2.9) were the best predictors of RVAD need.
CONCLUSIONS: The most significant predictors for RVAD need were cardiac index, RV stroke work index, severe pre-operative RV dysfunction, creatinine, previous cardiac surgery and systolic blood pressure. Using these data, we constructed an algorithm that can predict which LVAD patients will require RVAD with >80% sensitivity and specificity.
Authors:
J Raymond Fitzpatrick; John R Frederick; Vivian M Hsu; Elliott D Kozin; Mary Lou O'Hara; Elan Howell; Deborah Dougherty; Ryan C McCormick; Carine A Laporte; Jeffrey E Cohen; Kevin W Southerland; Jessica L Howard; Mariell L Jessup; Rohinton J Morris; Michael A Acker; Y Joseph Woo
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation     Volume:  27     ISSN:  1557-3117     ISO Abbreviation:  J. Heart Lung Transplant.     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-12-08     Completed Date:  2009-06-19     Revised Date:  2014-09-02    
Medline Journal Info:
Nlm Unique ID:  9102703     Medline TA:  J Heart Lung Transplant     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1286-92     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Blood Pressure
Diabetes Complications / epidemiology
Equipment Design
Female
Heart Failure / physiopathology*,  surgery
Heart Transplantation*
Heart-Assist Devices* / adverse effects
Hemodynamics
Humans
Male
Middle Aged
Predictive Value of Tests
Pulmonary Disease, Chronic Obstructive / epidemiology
Retrospective Studies
Risk Assessment
Risk Factors
Ventricular Dysfunction, Left / epidemiology,  physiopathology,  surgery*
Ventricular Dysfunction, Right / physiopathology,  surgery*
Ventricular Function, Right
Grant Support
ID/Acronym/Agency:
K08 HL072812/HL/NHLBI NIH HHS; K08 HL072812-02/HL/NHLBI NIH HHS; K08 HL072812-03/HL/NHLBI NIH HHS; K08 HL072812-04/HL/NHLBI NIH HHS
Comments/Corrections
Comment In:
J Heart Lung Transplant. 2011 Dec;30(12):1419   [PMID:  21925904 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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