Concurrent RVAD Improves Survival for Patients with RV Failure at the Time of LVAD Implantation

Horstmanshof, Douglas; George, S.; Becker, C.A.; Patrick, Angela; Banayosy, A.M. El; Gorthi, Janardhana; Cunningham, Luke; Eshelbrenner, Carrie; Phancao, Anita; Long, James W.

doi:10.1016/j.healun.2020.01.166

Cited by 3 publications

(1 citation statement)

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“…Our results indicate that patients with right ventricular graft dysfunction due to increased afterload have markedly better short‐term survival compared to all other groups of mechanically supported recipients. While concurrent as opposed to delayed RVAD implantation in patients with RV failure at the time of LVAD implantation has been associated with improved short‐ and long‐term survival, ideal timing of RVAD insertion for RV dysfunction post‐transplantation is less well studied 22 . Delayed RVAD implantation in patients with post‐transplantation RV failure due to increased afterload did not negatively impact the outcome, likely because in all patients, RVAD was placed before the development of multisystem organ failure.…”

Section: Discussionmentioning

confidence: 98%

Impact of temporary mechanical circulatory support for early graft failure on post–heart transplantation outcomes

Urban

Lundgren

Siddique

et al. 2020

Clinical Transplantation

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Although temporary mechanical circulatory support (tMCS) for hemodynamic failure following heart transplantation is associated with increased early morbidity and mortality, the impact of etiology of graft dysfunction and long-term clinical implications are less well known. The objective of our study was to evaluate outcomes in patients who required venoarterial extracorporeal membrane oxygenation (VA ECMO) or temporary right ventricular assist device (RVAD) support for either primary or secondary early graft dysfunction. Hospital mortality in 27 patients who required tMCS following heart transplantation at our institution between 2007 and 2017 was 56%, 30% in patients with right ventricular dysfunction secondary to increased afterload, 60% in patients with primary graft dysfunction, and 100% in patients with graft failure secondary to coagulopathy with intraoperative bleeding or overwhelming sepsis. Conditional 1-year and 5-year survival was comparable between patients with, and without, the need for post-transplantation support with tMCS (98% and 89%; 92% and 65% at 1 and 5 years, P = .21). Etiology of early graft failure plays an important part in determining the short-term post-heart transplantation outcome. Although complications associated with tMCS use, such as renal dysfunction and infection, extend beyond index transplant hospitalization, long-term conditional survival is not compromised.

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Section: Discussionmentioning

confidence: 98%

Impact of temporary mechanical circulatory support for early graft failure on post–heart transplantation outcomes

Urban

Lundgren

Siddique

et al. 2020

Clinical Transplantation

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Significance of pre and post-implant MELD-XI score on survival in children undergoing VAD implantation

Boyle

Cantor

Conway

et al. 2021

The Journal of Heart and Lung Transplantation

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Different ECLS Pump Configurations for Temporary Right Ventricular Assist Device in LVAD Patients: A Retrospective Case–Control Study

Opacic,

Klüß,

Radakovic

et al. 2024

Life

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Background: Acute right ventricular failure is a critical complication after left ventricular assist device (LVAD) implantation, often managed with a temporary paracorporeal right ventricular assist device (RVAD). This study examined three extracorporeal life support (ECLS) systems regarding mortality, bleeding complications, and intensive care unit (ICU) stay duration. Methods: This monocentric, retrospective case–control study included all patients receiving LVAD with paracorporeal RVAD between 2009 and 2020. Three patient groups were formed: CentrimagTM (A), CardiohelpTM (B), and DeltastreamTM (C). Results: A total of 245 patients were included. Preoperative parameters were similar between the CentrimagTM and DeltastreamTM groups, but CardiohelpTM patients had worse Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Scores (A: 1.7 ± 0.8, B: 1.36 ± 0.5, C: 1.9 ± 0.9; p < 0.05). In-hospital death rates were A: 61 (41.8%), B: 15 (32.6%), C: 29 (54.7%); p < 0.05, and reoperation due to bleeding rates were A: 32 (21.9%), B: 8 (17.4%), C: 25 (47.2%); p < 0.05, with the DeltastreamTM group showing the highest rates. This group also had increased thrombocyte consumption and prolonged ICU stays. Conclusions: Temporary RVADs lead to bleeding complications, affecting patient outcomes. The DeltastreamTM group had significantly higher bleeding complications, likely due to high pump revolution rates and thrombocyte decline. Due to the study’s retrospective nature and complex patient profiles, these interesting findings should be validated in future studies.

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Concurrent RVAD Improves Survival for Patients with RV Failure at the Time of LVAD Implantation

Cited by 3 publications

References 0 publications

Impact of temporary mechanical circulatory support for early graft failure on post–heart transplantation outcomes

Impact of temporary mechanical circulatory support for early graft failure on post–heart transplantation outcomes

Significance of pre and post-implant MELD-XI score on survival in children undergoing VAD implantation

Different ECLS Pump Configurations for Temporary Right Ventricular Assist Device in LVAD Patients: A Retrospective Case–Control Study

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