A Useful Scoring System For Predicting Right Ventricular Assist Device Requirement Among Patients with a Paracorporeal Left Ventricular Assist Device
Autor: | Daisuke Nitta, Kan Nawata, Osamu Kinoshita, Koichiro Kinugawa, Issei Komuro, Masaru Hatano, Teruhiko Imamura, Minoru Ono, Eisuke Amiya |
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Rok vydání: | 2018 |
Předmět: |
Adult
Male medicine.medical_specialty Heart Ventricles Ventricular Dysfunction Right medicine.medical_treatment Cardiac index Diastole Pulmonary Artery 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Risk Factors Internal medicine medicine.artery medicine Humans Pulmonary Wedge Pressure Pulmonary wedge pressure Retrospective Studies Heart Failure business.industry Incidence Hemodynamics Stroke Volume General Medicine Middle Aged Prognosis medicine.disease Right Ventricular Assist Device medicine.anatomical_structure 030228 respiratory system Echocardiography Heart failure Ventricular assist device Preoperative Period Pulmonary artery Ventricular Function Right Cardiology Vascular resistance Female Vascular Resistance Heart-Assist Devices Cardiology and Cardiovascular Medicine business |
Zdroj: | International Heart Journal. 59:983-990 |
ISSN: | 1349-3299 1349-2365 |
Popis: | Ventricular assist devices (VADs) have become an important therapy for advanced heart failure, however, the prognosis of those who receive a biventricular assist device (BiVAD) is still poor. We enrolled 70 patients who underwent paracorporeal VAD (Nipro-VAD®) implantation between 2004 and 2015 and studied the preoperative risk factors, including hemodynamic parameters for RVAD requirement. Furthermore, 2-year survival was compared between the BiVAD group and LVAD only group. Fourteen patients (20%) required RVAD. The BiVAD group had a significantly smaller left ventricular diastolic/systolic dimension, lower mean pulmonary artery wedge pressure (PAWP), lower cardiac index (CI), higher pulmonary vascular resistance (PVR), higher mean right atrial pressure (RAP), lower pulmonary artery pulsatility index (PAPi), lower right ventricular stroke work index (RVSWI), and higher mean RAP/mean PAWP ratio preoperatively. After multivariate analysis, only PVR > 4.5 Wood units: WU (P = 0.013, odds ratio: OR 7.9) and mean RAP/mean PAWP > 0.8 (P 4.5 WU and 2 points to mean RAP/mean PAWP > 0.8. This simple scoring method adequately stratified the incidence of RVAD implantation (score 0: 4.4%, score 1: 28.6%, score 2: 41.7%, score 3: 83.3%). The cumulative survival rate at 2-year after VAD implantation was significantly worse among patients who required RVAD support compared to the LVAD only group (28.5% versus 74.4%, P = 0.009). RVAD requirement is associated with poor long-term survival, and this simple scoring system using PVR and mean RAP/mean PAWP may be useful for predicting RVAD requirement in such patients. |
Databáze: | OpenAIRE |
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