Strategies for Mechanical Right Ventricular Support During Left Ventricular Assist Device Implant
Autor: | Leora T. Yarboro, Zachary K. Wegermann, Vinod H. Thourani, Nicholas R. Teman, Vinay Badhwar, Sean M. O'Brien, J. Matthew Brennan, Jared P. Beller, Maria V. Grau-Sepulveda, J. Hunter Mehaffey, Gorav Ailawadi, Francis D. Pagani |
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Rok vydání: | 2022 |
Předmět: |
Pulmonary and Respiratory Medicine
Inotrope medicine.medical_specialty Ventricular Dysfunction Right medicine.medical_treatment Extracorporeal Membrane Oxygenation Internal medicine medicine Extracorporeal membrane oxygenation Humans Retrospective Studies Heart Failure business.industry medicine.disease Right Ventricular Assist Device Treatment Outcome Ventricular assist device Heart failure Circulatory system Cardiology Right ventricular failure Surgery Heart-Assist Devices Implant Cardiology and Cardiovascular Medicine business |
Zdroj: | The Annals of Thoracic Surgery. 114:484-491 |
ISSN: | 0003-4975 |
Popis: | Refractory right ventricular failure at the time of left ventricular assist device implantation requires treatment with supplemental mechanical circulatory support. However, the optimal strategy for support remains unknown.All patients undergoing first-time durable left ventricular assist device implantation with a contemporary device were selected from The Society of Thoracic Surgeons National Database (2011 to 2019). Patients requiring right ventricular assist device (RVAD) or venoarterial extracorporeal membrane oxygenation (VA-ECMO) were included in the analysis. Patients were stratified by RVAD or VA-ECMO and by timing of placement (intraoperative vs postoperative).In all, 18 423 left ventricular assist device implants were identified, of which 940 (5.1%) required RVAD (n = 750) or VA-ECMO (n = 190) support. Patients receiving an RVAD more frequently had preoperative inotrope requirement (76% vs 62%, P.01) and severe tricuspid regurgitation (20% vs 13%, P.01). The RVAD patients had lower rates of postoperative renal failure (40% vs 51%, P = .02) and limb ischemia (4% vs 13%, P.01), as well as significantly less operative mortality (41% vs 54%, P.01). After risk adjustment with propensity score analysis, support with VA-ECMO was associated with a higher risk of mortality (risk ratio 1.46; 95% confidence interval, 1.21 to 1.77; P.01) compared with patients receiving an RVAD. Importantly, institution of right ventricular support postoperatively was associated with higher mortality (1.43, P.01) compared with intraoperative initiation.Patients with severe right ventricular failure in the setting of durable left ventricular assist device implantation may benefit from the use of RVAD over VA-ECMO. Regardless of the type of support, initiation at the index operation was associated with improved outcomes. |
Databáze: | OpenAIRE |
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