Effects of Percutaneous LVAD Support on Right Ventricular Load and Adaptation

Autor: Ryan J. Tedford, Adrian B. Van Bakel, Michael L. Craig, Bhavadharini Ramu, Daniel H. Steinberg, M. Christopher Armstrong, Brian A. Houston, Prabodh Mishra, Jeffrey P. Yourshaw, Thomas G. DiSalvo
Rok vydání: 2018
Předmět:
Male
0301 basic medicine
medicine.medical_specialty
Cardiac output
Time Factors
Percutaneous
medicine.medical_treatment
Shock
Cardiogenic
Pharmaceutical Science
Hemodynamics
030204 cardiovascular system & hematology
Prosthesis Design
Ventricular Function
Left
Prosthesis Implantation
03 medical and health sciences
0302 clinical medicine
Internal medicine
Genetics
medicine
Humans
Pulmonary wedge pressure
Genetics (clinical)
Retrospective Studies
business.industry
Cardiogenic shock
Central venous pressure
Recovery of Function
Middle Aged
medicine.disease
Adaptation
Physiological
Treatment Outcome
030104 developmental biology
medicine.anatomical_structure
Ventricular assist device
Ventricular Function
Right
Vascular resistance
Cardiology
Molecular Medicine
Female
Heart-Assist Devices
Cardiology and Cardiovascular Medicine
business
Zdroj: Journal of Cardiovascular Translational Research. 12:142-149
ISSN: 1937-5395
1937-5387
DOI: 10.1007/s12265-018-9806-0
Popis: Both operative and hemodynamic mechanisms have been implicated in right heart failure (RHF) following surgical left ventricular assist device (LVAD) implantation. We investigated the effects of percutaneous LVAD (pLVAD; Impella®, Abiomed) support on right ventricular (RV) load and adaptation. We reviewed all patients receiving a pLVAD for cardiogenic shock at our institution between July 2014 and April 2017, including only those with pre- and post-pLVAD invasive hemodynamic measurements. Hemodynamic data was recorded immediately prior to pLVAD implantation and up to 96 h post-implantation. Twenty-five patients were included. Cardiac output increased progressively during pLVAD support. PAWP improved early post-pLVAD but did not further improve during continued support. Markers of RV adaptation (right ventricular stroke work index, right atrial pressure (RAP), and RAP to pulmonary artery wedge pressure ratio (RAP:PAWP)) were unchanged acutely implant but progressively improved during continued pLVAD support. Total RV load (pulmonary effective arterial elastance; EA) and resistive RV load (pulmonary vascular resistance; PVR) both declined progressively. The relationship between RV load and RV adaptation (EA/RAP and EA/RAP:PAWP) was constant throughout. Median vasoactive-inotrope score declined after pLVAD placement and continued to decline throughout support. Percutaneous LVAD support in patients with cardiogenic shock did not acutely worsen RV adaptation, in contrast to previously described hemodynamic effects of surgically implanted durable LVADs. Further, RV load progressively declined during support, and the noted RV adaptation improvement was load-dependent as depicted by constant EA/RA and EA/RAP:PAWP relationships. These findings further implicate the operative changes associated with surgical LVAD implantation in early RHF following durable LVAD.
Databáze: OpenAIRE
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