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
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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