Decision tree for adjuvant right ventricular support in patients receiving a left ventricular assist device

Wang, Yajuan; Simon, Marc A.; Bonde, Pramod; Harris, Bronwyn; Teuteberg, Jeffrey J.; Kormos, Robert L.; Antaki, James F.

doi:10.1016/j.healun.2011.11.003

Cited by 117 publications

(83 citation statements)

References 34 publications

(41 reference statements)

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“…[5][6][7][8][9] Most studies have reported the incidence encompassing the need for inotropic support with or without RVAD (≥ 14 days) after LVAD implant, with a range of between 20.2% to 44%. [10][11][12] We know that prolonged RV failure (i.e., extended inotrope support) for more than 2 weeks is associated with adverse subsequent outcomes.…”

Section: Definition and Incidence Of Right Ventricular Failure After mentioning

confidence: 99%

“…Reverse remodeling of pulmonary vasculature can potentially occur by continuing unloading, and, unlike for heart transplantation, elevated pulmonary vascular resistance does not predict postimplant RVF. 7,11,12 Surrogates of reduced RV contractility, i.e., low pulmonary artery systolic pressure, and RV stroke work index remain markers of risk but have not yielded substantial predictive information. 8,10,12,16 A CVP/PCWP ratio > 0.63 was shown to be an independent predictor of early RVF risk in the HeartMate II Bridge-to-Transplantation Pivotal Trial population with overall low discrimination (0.68).…”

Section: Risk Factors and Risk Prediction Models For Rvf Postimplantamentioning

confidence: 99%

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Predictors and Management of Right Heart Failure after Left Ventricular Assist Device Implantation

Fida¹,

Loebe²,

Estep³

et al. 2015

Methodist DeBakey Cardiovascular Journal

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Early recognition and improved outcomes of ischemic heart disease has resulted in an aging population and a global increase in the prevalence of heart failure (HF).1 Consequently, the burden of stage D heart failure (HF), which is unresponsive to conventional medical therapy, has surpassed the availability of the finite donor organ pool. 2 Significant advances in the field of mechanical circulatory support has made destination therapy (DT) with left ventricular assist devices (LVADs) a promising alternative to heart transplantation, with 1-year postimplant actuarial survival at about 80% with a continuous flow LVAD (CF-LVAD). 3However, despite newer technology and greater familiarity with patient management, physicians continue to be confronted by early and/or late right ventricular failure (RVF) that significantly impacts survival post-LVAD implantation. As none of the current mechanical circulatory support (MCS) devices are approved for DT for solitary right heart support or biventricular support, it is critical to identify preoperative predictors of right heart failure post-LVAD implant. Definition and Incidence of Right Ventricular Failure after LVAD PlacementIn the absence of a universally agreed-upon definition of RVF after LVAD placement, its reported incidence varies with the institutional practice, the United Network for Organ Sharing (UNOS) indication for MCS, the device type, and the criteria used to define failure. Additionally, it is now recognized that RVF is a progressive condition that can occur beyond the immediate postoperative period. However, this emerging concept of "late RVF" remains ill-defined and difficult to predict. The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) defines RVF as persistent signs and symptoms of RV dysfunction evident by central venous pressure (CVP) > 18 mm Hg with a cardiac index (CI) < 2.0 L/min/m 2 in the absence of increased left atrial filling pressure/pulmonary capillary wedge pressure (PCWP) > 18 mm Hg, cardiac tamponade, ventricular arrhythmias, and/or pneumothorax requiring either right ventricular assist device (RVAD) implantation or inhaled nitric oxide or inotropic therapy for ≥ 14 days after LVAD implantation. 4 According to INTERMACS, RVF severity is described as follows:• Severe, when there is a need for RVAD; • Moderate, when inotropes or intravenous or inhaled pulmonary vasodilators are used; and • Mild, when a combination of ≥ 2 signs and symptoms are present but without the need for RVAD or inotropic and/ or vasodilator support. Signs and symptoms include CVP > 18 mm Hg, CI < 2.3 L/min/m 2 , ascites, moderate to severe peripheral edema, or evidence of high CVP on physical exam or transthoracic echocardiogram.The incidence of severe RVF necessitating RVAD placement after LVAD or preemptive BiVAD support is reported to be anywhere from 9.4% to 37.0%. [5][6][7][8][9] Most studies have reported the incidence encompassing the need for inotropic support with or without RVAD (≥ 14 days) after LVAD implant, with a range of b...

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Section: Definition and Incidence Of Right Ventricular Failure After mentioning

confidence: 99%

Section: Risk Factors and Risk Prediction Models For Rvf Postimplantamentioning

confidence: 99%

Predictors and Management of Right Heart Failure after Left Ventricular Assist Device Implantation

Fida¹,

Loebe²,

Estep³

et al. 2015

Methodist DeBakey Cardiovascular Journal

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“…In this work, we use the algorithm C4.5, proposed by Quinlan, to improve the algorithm ID3 [46] and it is considered a standard model in supervised classification. The C4.5 has advantages such as its intuitive structure that is closer to clinical reasoning and therefore it can be more readily interpreted [47]. In addition, it performs implicitly variable screening or featuring selection [48].…”

Section: Decision Treesmentioning

confidence: 99%

Aid decision algorithms to estimate the risk in congenital heart surgery

Ruiz-Fernández

Torra

Soriano-Payá

et al. 2016

Computer Methods and Programs in Biomedicine

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A c c e p t e d M a n u s c r i p t Highlights  We propose an alternative system for classifying the risk in paediatric congenital heart surgery. Four methods are tested: a perceptron multilayer, self-organising maps, a radial basis function neural network and decision trees. We obtain an accuracy of 99.87% (using pre and post-surgical data) and 83% (using just pre-surgical data).Page 2 In this paper, we have tested the suitability of using different artificial intelligence-based algorithms for decision support when classifying the risk of congenital heart surgery. In this sense, classification of those surgical risks provides enormous benefits as the a priori estimation of surgical outcomes depending on either the type of disease or the type of repair, and other elements that influence the final result. This preventive estimation may help to avoid future complications, or even death. MethodsWe have evaluated four machine learning algorithms to achieve our objective: multilayer perceptron, self-organizing map, radial basis function networks and decision trees. The architectures implemented have the aim of classifying among three types of surgical risk: low complexity, medium complexity and high complexity. ResultsAccuracy outcomes achieved range between 80% and 99%, being the multilayer perceptron method the one that offered a higher hit ratio. ConclusionsAccording to the results, it is feasible to develop a clinical decision support system using the evaluated algorithms. Such system would help cardiology specialists, paediatricians and surgeons to forecast the level of risk related to a congenital heart disease surgery.

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“…Several algorithms exist to distinguish patients likely to require biventricular support, and this aspect is of critical importance because of the lack of optimal outcomes, especially in the setting of transplantationineligible patients. [17][18][19] …”

Section: Selection Of the Appropriate Patient For Lifetime Mcs Therapymentioning

confidence: 99%

Should Left Ventricular Assist Device Should Be Standard of Care for Patients With Refractory Heart Failure Who Are Not Transplantation Candidates?

Mehra

Domanski

2012

Circulation

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T he development of current mechanical circulatory support (MCS) systems began in the 1960s as an effort to provide a therapeutic option for patients with refractory advanced heart failure. 1 Today, MCS represents a viable alternative to cardiac transplantation for the overwhelming majority of patients in whom age, comorbidities, or the profound shortage of donors makes transplantation infeasible. Response by Owens and Jessup on p 3087Painstaking work on the technique of orthotopic cardiac transplantation, coupled with advances in the knowledge of immunology, resulted in the improvements in survival and quality of life that make cardiac transplantation the treatment of choice for individuals with advanced heart failure. MCS has only recently become accepted for widespread clinical use. 2 Early MCS designs were based on the assumption that maintaining pulsatility of flow was a physiological necessity. These bulky devices were of limited durability and resulted in a great deal of morbidity in the form of hematologic, neurological, and infectious complications. 3 Current (secondand third-generation) devices deliver continuous flow (either axial [HeartMate II] or centrifugal [Heartware HVAD]) and have far fewer moving parts (only a rotor); as a result, they are smaller, quieter, and far more durable (estimated to last Ն10 years compared with 18 months) than the early pulsatile systems. 4 Although no longer in common use, early pulsatileflow left ventricular assist devices (LVADs) provided the first proof of principle that MCS can extend life of wellselected patients with advanced heart failure refractory to traditional optimal medical therapy. The development of continuous-flow devices has made MCS a practical clinical tool, and outcomes with the newer devices provide a convincing rationale for LVADs as standard of care in wellselected patients with refractory heart failure in whom transplantation is not an option.

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Decision tree for adjuvant right ventricular support in patients receiving a left ventricular assist device

Cited by 117 publications

References 34 publications

Predictors and Management of Right Heart Failure after Left Ventricular Assist Device Implantation

Predictors and Management of Right Heart Failure after Left Ventricular Assist Device Implantation

Aid decision algorithms to estimate the risk in congenital heart surgery

Should Left Ventricular Assist Device Should Be Standard of Care for Patients With Refractory Heart Failure Who Are Not Transplantation Candidates?

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