Can Perioperative Right Ventricular Support Prevent Postoperative Right Heart Failure in Patients With Biventricular Dysfunction Undergoing Left Ventricular Assist Device Implantation?

被引：31
作者：
Deschka, Heinz [1 ]
Holthaus, Alexander J. [1 ]
Sindermann, Juergen R. [1 ]
Welp, Henryk [1 ]
Schlarb, Dominik [2 ]
Monsefi, Nadejda [3 ]
Martens, Sven [1 ]
Scherer, Mirela [1 ]
机构：
[1] Univ Hosp Munster, Div Cardiac Surg, Dept Cardiothorac Surg, Albert Schweitzer Campus 1, D-41849 Munster, Germany
[2] Fachklin Hornheide, Dept Plast & Aesthet Surg, Munster, Germany
[3] Goethe Univ Frankfurt, Dept Thorac & Cardiovasc Surg, Frankfurt, Germany
来源：
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA | 2016年 / 30卷 / 03期
关键词：
left ventricular assist device; right ventricular assist device; circulatory support devices; right heart failure; MECHANICAL CIRCULATORY SUPPORT; HIGH-RISK; MANAGEMENT; RECIPIENTS; SURVIVAL;
D O I：
10.1053/j.jvca.2016.02.023
中图分类号：
R614 [麻醉学];
学科分类号：
100217 ;
摘要：
Objectives: Depending on the pre-existing condition of the right ventricle (RV), left ventricular assist device (LVAD) implantation may have a detrimental effect on RV function, subsequently leading to right heart failure. This study details the authors' experience with perioperative mechanical RV support in patients with biventricular impairment but primarily scheduled for isolated LVAD implantation. Design: Retrospective study. Setting: Two center study, university hospital. Participants: This study included LVAD recipients with preoperative biventricular impairment who received an additional right ventricular assist device (RVAD) after a failed weaning attempt from cardiopulmonary bypass due to acute RV failure. Interventions: Outcomes of 25 patients who underwent LVAD and unplanned temporary RVAD implantation were analyzed. Measurements and Main Results: All patients experienced significant preoperative RV impairment (tricuspid annular plane systolic excursion: 10.2 +/- 26.3 mm; right atrium pressure: 17.9 +/- 10.4 mmHg) and pulmonary hypertension (pulmonary artery pressure: 54.8 +/- 25.7 mmHg). In 15 patients, additional tricuspid valve annuloplasty was performed. Mean duration of temporary RVAD support was 11.1 +/- 7.2 days. In 23 patients (92%), the RVAD was removed successfully. None of the patients developed RV failure after RVAD removal. Hospital survival and the 1-year survival rate of the study group were 68% and 56%, respectively. Conclusions: The results of perioperative RVAD support in LVAD recipients with biventricular dysfunction are encouraging. Temporary RVAD support allows an already compromised RV to become attuned to the hemodynamic conditions after LVAD implantation. This strategy provides patients with preoperative impaired RV function a high likelihood to permanently undergo LVAD support only. (C) 2016 Elsevier Inc. All rights reserved.
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收藏
页码：619 / 626
页数：8
相关论文
共 33 条
[1]   Assessment of right ventricular dysfunction predictors before the implantation of a left ventricular assist device in end-stage heart failure patients using echocardiographic measures (ARVADE): Combination of left and right ventricular echocardiographic variables [J].
Aissaoui, Nadia ;
Salem, Joe-Elie ;
Paluszkiewicz, Lech ;
Morshuis, Michiel ;
Guerot, Emmanuel ;
Gorria, Gonzalo Martin ;
Fagon, Jean-Yves ;
Gummert, Jan ;
Diebold, Benoit .
ARCHIVES OF CARDIOVASCULAR DISEASES, 2015, 108 (05) :300-309
[2]   Comparison of Biventricular and Left Ventricular Assist Devices for the Management of Severe Right Ventricular Dysfunction in Patients with End-Stage Heart Failure [J].
Aissaoui, Nadia ;
Morshuis, Michiel ;
Paluszkiewicz, Lech ;
Lauenroth, Volker ;
Boergermann, Jochen ;
Gummert, Jan .
ASAIO JOURNAL, 2014, 60 (04) :400-406
[3]   Temporary right ventricular mechanical circulatory support for the management of right ventricular failure in critically ill patients [J].
Aissaoui, Nadia ;
Morshuis, Michiel ;
Schoenbrodt, Michael ;
Meibodi, Kavous Hakim ;
Kizner, Lukasz ;
Boergermann, Jochen ;
Gummert, Jan .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2013, 146 (01) :186-191
[4]   Predicting Right Ventricular Failure in the Modern, Continuous Flow Left Ventricular Assist Device Era [J].
Atluri, Pavan ;
Goldstone, Andrew B. ;
Fairman, Alex S. ;
MacArthur, John W. ;
Shudo, Yasuhiro ;
Cohen, Jeffrey E. ;
Acker, Alexandra L. ;
Hiesinger, William ;
Howard, Jessica L. ;
Acker, Michael A. ;
Woo, Y. Joseph .
ANNALS OF THORACIC SURGERY, 2013, 96 (03) :857-864
[5]   Survival after biventricular assist device implantation: An analysis of the Interagency Registry for Mechanically Assisted Circulatory Support database [J].
Cleveland, Joseph C., Jr. ;
Naftel, David C. ;
Reece, T. Brett ;
Murray, Margaret ;
Antaki, James ;
Pagani, Francis D. ;
Kirklin, James K. .
JOURNAL OF HEART AND LUNG TRANSPLANTATION, 2011, 30 (08) :862-869
[6]   Right ventricular failure after implantation of a continuous-flow left ventricular assist device: early haemodynamic predictors [J].
Cordtz, Joakim ;
Nilsson, Jens C. ;
Hansen, Peter B. ;
Sander, Kaare ;
Olesen, Peter S. ;
Boesgaard, Soren ;
Gustafsson, Finn .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2014, 45 (05) :847-853
[7]   Predicting Survival in Patients Receiving Continuous Flow Left Ventricular Assist Devices The HeartMate II Risk Score [J].
Cowger, Jennifer ;
Sundareswaran, Kartik ;
Rogers, Joseph G. ;
Park, Soon J. ;
Pagani, Francis D. ;
Bhat, Geetha ;
Jaski, Brian ;
Farrar, David J. ;
Slaughter, Mark S. .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2013, 61 (03) :313-321
[8]   Left ventricular vs. biventricular mechanical support: Decision making and strategies for avoidance of right heart failure after left ventricular assist device implantation [J].
Dandel, Michael ;
Krabatsch, Thomas ;
Falk, Volkmar .
INTERNATIONAL JOURNAL OF CARDIOLOGY, 2015, 198 :241-250
[9]   Risk Factors Predictive of Right Ventricular Failure After Left Ventricular Assist Device Implantation [J].
Drakos, Stavros G. ;
Janicki, Lindsay ;
Horne, Benjamin D. ;
Kfoury, Abdallah G. ;
Reid, Bruce B. ;
Clayson, Stephen ;
Horton, Kenneth ;
Haddad, Francois ;
Li, Dean Y. ;
Renlund, Dale G. ;
Fisher, Patrick W. .
AMERICAN JOURNAL OF CARDIOLOGY, 2010, 105 (07) :1030-1035
[10]   Early planned institution of biventricular mechanical circulatory support results in improved outcomes compared with delayed conversion of a left ventricular assist device to a biventricular assist device [J].
Fitzpatrick, J. Raymond, III ;
Frederick, John R. ;
Hiesinger, William ;
Hsu, Vivian M. ;
McCormick, Ryan C. ;
Kozin, Elliott D. ;
Laporte, Carine M. ;
O'Hara, Mary Lou ;
Howell, Elan ;
Dougherty, Deborah ;
Cohen, Jeffrey E. ;
Southerland, Kevin W. ;
Howard, Jessica L. ;
Paulson, Carter ;
Acker, Michael A. ;
Morris, Rohinton J. ;
Woo, Y. Joseph .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2009, 137 (04) :971-977
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