Are right ventricular risk scores useful?

Pettinari, Matteo; Jacobs, Steven; Rega, Filip; Verbelen, Tom; Droogné, Walter; Meyns, Bart

doi:10.1093/ejcts/ezs104

Cited by 44 publications

(40 citation statements)

References 23 publications

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“…Nevertheless, the performance of models derived in pulsatile-flow LVAD cohorts has been shown to be problematic for prediction of RVAD need in a previous study of 59 continuous-flow LVAD patients. 13 In comparison to the populations in previous RVF investigations, our cohort was comprised of continuous-flow LVAD recipients exclusively, and we had a higher proportion of DT recipients, reflecting the changes in practice over time. These factors are likely to have contributed to model underperformance.…”

Section: Discussionmentioning

confidence: 99%

“…However, both older and newer risk score models have undergone limited external validation. 13 Considering that RVF remains a major cause of morbidity and mortality after LVAD implantation, obtaining an RVF risk prediction score is essential for improving outcomes. In this study, we aimed to comprehensively assess the performance of both older and newer scores in their ability to discriminate RVF in a single-center continuous-flow LVAD cohort.…”

mentioning

confidence: 99%

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Validation of clinical scores for right ventricular failure prediction after implantation of continuous-flow left ventricular assist devices

Kalogeropoulos

Kelkar

Weinberger

et al. 2015

The Journal of Heart and Lung Transplantation

113

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Validation of clinical scores for right ventricular failure prediction after implantation of continuous-flow left ventricular assist devices

Kalogeropoulos

Kelkar

Weinberger

et al. 2015

The Journal of Heart and Lung Transplantation

113

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“…A number of RHF prediction rules have been previously developed 2, 6–10 . However, available risk scores have been typically derived from single-center cohorts, employed variable definitions of RHF, identified inconsistent predictors 11, 12 , and have demonstrated modest predictive value when validated in independent cohorts 12 . The goal of the this study was to further explore pre-implant characteristics associated with right ventricular assist device (RVAD) use in patients undergoing continuous-flow (CF) LVAD surgery utilizing data from the multicenter Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS).…”

mentioning

confidence: 99%

Early Right Ventricular Assist Device Use in Patients Undergoing Continuous-Flow Left Ventricular Assist Device Implantation

Kiernan

Grandin

Brinkley

et al. 2017

Circ: Heart Failure

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Background To investigate pre-implant risk factors associated with early right ventricular assist device (RVAD) use in patients undergoing continuous-flow left ventricular assist device (CF-LVAD) surgery. Methods and Results Patients in the INTERMACS registry who underwent primary CF-LVAD surgery were examined for concurrent or subsequent RVAD implantation within 14 days of LVAD. Risk factors for RVAD implantation and the combined endpoint of RVAD or death within 14 days of LVAD were assessed with stepwise logistic regression. We compared survival between patients with and without RVAD using Kaplan-Meier method and Cox proportional hazards modeling. Of 9,976 patients undergoing CF-LVAD implantation, 386 patients (3.9%) required an RVAD within 14 days of LVAD surgery. Pre-implant characteristics associated with RVAD use included INTERMACS patient profiles 1 and 2, the need for preoperative ECMO or renal replacement therapy, severe pre-implant tricuspid regurgitation, history of prior cardiac surgery, and concomitant procedures other than TV repair at the time of LVAD. Hemodynamic determinants included elevated right atrial pressure, reduced pulmonary artery pulse pressure, and reduced stroke volume. The final model demonstrated good performance for both RVAD implant (AUC 0.78) and the combined end-point of RVAD or death within 14 days (AUC 0.73). Compared to patients receiving an isolated LVAD, patients requiring RVAD had decreased 1- and 6-month survival: 78.1% versus 95.8% and 63.6% versus 87.9% respectively (p<0.0001 for both). Conclusions The need for RVAD implantation after LVAD is associated with indices of global illness severity, markers of end-organ dysfunction and profiles of hemodynamic instability.

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“…Nonetheless, determination of risk for RV failure after LVAD placement remains difficult. One recent small series demonstrated no predictive value from several of the scoring systems in predicting the need for RV support 16 .…”

Section: Representative Resultsmentioning

confidence: 99%

Implantation of the Syncardia Total Artificial Heart

Tang

Shah

Hess

et al. 2014

JoVE

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With advances in technology, the use of mechanical circulatory support devices for end stage heart failure has rapidly increased. The vast majority of such patients are generally well served by left ventricular assist devices (LVADs). However, a subset of patients with late stage biventricular failure or other significant anatomic lesions are not adequately treated by isolated left ventricular mechanical support. Examples of concomitant cardiac pathology that may be better treated by resection and TAH replacement includes: post infarction ventricular septal defect, aortic root aneurysm / dissection, cardiac allograft failure, massive ventricular thrombus, refractory malignant arrhythmias (independent of filling pressures), hypertrophic / restrictive cardiomyopathy, and complex congenital heart disease. Patients often present with cardiogenic shock and multi system organ dysfunction. Excision of both ventricles and orthotopic replacement with a total artificial heart (TAH) is an effective, albeit extreme, therapy for rapid restoration of blood flow and resuscitation. Perioperative management is focused on end organ resuscitation and physical rehabilitation. In addition to the usual concerns of infection, bleeding, and thromboembolism common to all mechanically supported patients, TAH patients face unique risks with regard to renal failure and anemia.

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Are right ventricular risk scores useful?

Abstract: The use of risk scores failed to predict the need of RV support after LVAD. Stratification of the hazard with these scores should occur with extreme caution.

Cited by 44 publications

References 23 publications

Validation of clinical scores for right ventricular failure prediction after implantation of continuous-flow left ventricular assist devices

Validation of clinical scores for right ventricular failure prediction after implantation of continuous-flow left ventricular assist devices

Early Right Ventricular Assist Device Use in Patients Undergoing Continuous-Flow Left Ventricular Assist Device Implantation

Implantation of the Syncardia Total Artificial Heart

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