Impact of Preoperative Percutaneous Cardiopulmonary Support on Outcome Following Left Ventricular Assist Device Implantation

Abstract

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp echanical circulatory support with a left ventricular assist device (LVAD) has become a well-established procedure for patients with end-stage heart failure. Patient selection and timing of implantation, however, remain critical issues. Although several studies have identified pre-implantation risk factors in regard to mortality, 1,2 most are limited by the fact that few of the reported patients were supported by an LVAD for a prolonged period. Because prolonged LVAD support has become prevalent not only as a bridge to transplantation but also for destination therapy, it is important to find preoperative risk factors for patients supported by an LVAD for a prolonged period. Preoperative cardiogenic shock is recognized as one of the significant risk factors for mortality after LVAD implantation, 2,3 and percutaneous cardiopulmonary support (PCPS), has been utilized for patients in cardiogenic shock to improve and stabilize the preoperative condition of LVAD candidates. 4,5 Although those studies demonstrated that PCPS can effectively act as a bridge to LVAD therapy for patients in cardiogenic shock, the duration of LVAD support in previous studies was relatively short, and the impact of preoperative PCPS on long-term LVAD support is not known. In Japan, because of a severe donor shortage, the average LVAD support period before heart transplantation is >2 years, 6 which provides a unique opportunity to observe LVAD patients for prolonged periods. In the present study we retrospectively reviewed 103 consecutive patients to clarify the impact of preoperative PCPS on long-term survival following implantation of an LVAD. Methods PatientsThis study was conducted as a retrospective analysis of 103 consecutive cardiomyopathy patients who underwent LVAD implantation as a bridge to heart transplantation at National Cerebral and Cardiovascular Center, Osaka, between May Background: The purpose of the present study was to determine the impact of preoperative percutaneous cardiopulmonary support (PCPS) on long-term survival following implantation of a left ventricular assist device (LVAD).

Bridge to durable left ventricular assist device for refractory cardiogenic shock

“…Hemodynamic indices are reported to be reliable and strong predictors for severe right heart failure after LVAD insertion. 17,18,[22][23][24] However, in the present study, all hemodynamic values before durable LVAD in the BTB group were better than those in the nonbridging group, because the majority of BTB cases received right ventricular unloading by ECMO or CentriMag RVAD. These findings suggest that hemodynamic indices do not reflect true right ventricular function, and we may underestimate the possibility of biventricular failure in patients in refractory cardiogenic shock.…”

“…4 Others showed that an INTERMACS profile I or preoperative ECMO use was a risk factor for requiring postoperative RVAD after durable LVAD insertion. 4,22,23 In these reports, preoperative central venous pressure level was a predictor of postoperative severe right ventricular failure requiring RVAD. Hemodynamic indices are reported to be reliable and strong predictors for severe right heart failure after LVAD insertion.…”

Interaction between Warfarin and Linezolid in Patients with Left Ventricular Assist System in Japan

“…Possible mechanisms of interaction with warfarin involve metabolic inhibition and induction, vitamin K intake, and changes in plasma protein binding. However, the protein binding rate of linezolid is relatively low (31%) (19). In the present study, no significant difference was observed in the albumin level between before and after the initiation of linezolid therapy.…”

Novel Risk Scoring System With Preoperative Objective Parameters Gives a Good Prediction of 1-Year Mortality in Patients With a Left Ventricular Assist Device

“…In other words, the decision for PCPS insertion by a physician that automatically assigns a patient profile 1 does not necessarily predestine the worst prognosis. 24 Currently, implantable VADs have not been indicated in patients with profile 1 in Japan, and therefore the poor prognosis in the profile 1 group might be a consequence of extracorporeal LVAD use. We look forward to analyzing the prognosis of patients with profile 1 under the application of implantable continuous-flow LVADs.…”