A multi-institutional retrospective analysis on impact of RV acute mechanical support timing after LVAD implantation on 1-year mortality and predictors of RV acute mechanical support weaning.

Autor:	Kumar S; Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas., Derbala MH; Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio., Nguyen DT; Department of Pathology and Genomic Medicine, Institute for Academic Medicine, Houston Methodist Hospital, Houston, Texas., Ferrall J; Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio., Cefalu M; Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio., Rivas-Lasarte M; Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York; Advanced Heart Failure and Heart Transplant Unit, Hospital Univesitario Puerta de Hierro, Madrid, Spain., Rashid SMI; Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York., Joseph DT; Department of Internal Medicine, Houston Methodist Hospital, Houston, Texas., Graviss EA; Department of Pathology and Genomic Medicine, Institute for Academic Medicine, Houston Methodist Hospital, Houston, Texas; Department of Surgery, Houston Methodist Hospital, Houston, Texas., Goldstein D; Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York., Jorde UP; Department of Pathology and Genomic Medicine, Institute for Academic Medicine, Houston Methodist Hospital, Houston, Texas., Bhimaraj A; Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas., Suarez EE; Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas., Smith SA; Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio., Sims DB; Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York., Guha A; Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas. Electronic address: gashrith@houstonmethodist.org.
Jazyk:	angličtina
Zdroj:	The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation [J Heart Lung Transplant] 2022 Feb; Vol. 41 (2), pp. 244-254. Date of Electronic Publication: 2021 Oct 25.
DOI:	10.1016/j.healun.2021.10.005
Abstrakt:	Background: There is little insight into which patients can be weaned off right ventricular (RV) acute mechanical circulatory support (AMCS) after left ventricular assist device (LVAD) implantation. We hypothesize that concomitant RV AMCS insertion instead of postoperative implantation will improve 1-year survival and increase the likelihood of RV AMCS weaning. Methods: A multicenter retrospective database of 826 consecutive patients who received a HeartMate II or HVAD between January 2007 and December 2016 was analyzed. We identified 91 patients who had early RV AMCS on index admission. Cox proportional-hazards model was constructed to identify predictors of 1-year mortality post-RV AMCS implantation and competing risk modeling identified RV AMCS weaning predictors. Results: There were 91 of 826 patients (11%) who required RV AMCS after CF-LVAD implantation with 51 (56%) receiving a concomitant RV AMCS and 40 (44%) implanted with a postoperative RV AMCS during their ICU stay; 48 (53%) patients were weaned from RV AMCS support. Concomitant RV AMCS with CF-LVAD insertion was associated with lower mortality (HR 0.45 [95% CI 0.26-0.80], p = 0.01) in multivariable model (which included age, BMI, angiotensin-converting enzyme inhibitor use, and heart transplantation as a time-varying covariate). In the multivariate competing risk analysis, a TPG < 12 (SHR 2.19 [95% CI 1.02-4.70], p = 0.04) and concomitant RV AMCS insertion (SHR 3.35 [95% CI 1.73-6.48], p < 0.001) were associated with a successful wean. Conclusions: In patients with RVF after LVAD implantation, concomitant RV AMCS insertion at the time of LVAD was associated with improved 1-year survival and increased chances of RV support weaning compared to postoperative insertion. (Copyright © 2021 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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