Incidence and clinical significance of late right heart failure during continuous-flow left ventricular assist device support

Takeda, Koji; Takayama, Hiroo; Colombo, P.C.; Yuzefpolskaya, M.; Fukuhara, Shinichi; Han, Jiho; Kurlansky, Paul; Mancini, Donna; Naka, Yoshifumi

doi:10.1016/j.healun.2015.03.011

Cited by 130 publications

(94 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Repeat hemodynamic assessment can be used to identify RVF as a cause of persistent HF symptoms in patients on long-term support. Chronic RVF is associated with frequent hospitalizations, diuretic intolerance, renal and liver failure, need for inotropes, and increased mortality [53–56]. Precise hemodynamic mechanisms of chronic RVF warrant further investigation.…”

Section: Hemodynamic Changes At Specific Conditionsmentioning

confidence: 99%

Clinical implications of hemodynamic assessment during left ventricular assist device therapy

Imamura

Chung

Nguyen

et al. 2018

Journal of Cardiology

View full text Add to dashboard Cite

Left ventricular assist devices (LVADs) significantly improve outcomes of advanced heart failure patients. However, patients continue to have high readmission rates due to complications ranging from bleeding, thrombosis, heart failure, and infection. Considering that the hallmark benefit of LVAD therapy is improvement in hemodynamics (cardiac unloading and increased cardiac output), hemodynamic assessment on LVAD support is key to better understand these difficult complications and may serve as a tool to resolving them. In this review, we will discuss the hemodynamic changes following LVAD implantation, and the implications and prognostic impact of hemodynamic optimization on outcomes and complications.

show abstract

Section: Hemodynamic Changes At Specific Conditionsmentioning

confidence: 99%

Clinical implications of hemodynamic assessment during left ventricular assist device therapy

Imamura

Chung

Nguyen

et al. 2018

Journal of Cardiology

View full text Add to dashboard Cite

show abstract

“…1 Experience with LVADs is rapidly growing worldwide; however, mortality and morbidity of this advanced therapy remains high. 11 Severe RV dysfunction remains the leading cause of death in the first month after LVAD implantation. 4 Recently, novel LVAD designs have improved post-operative outcomes with a marked reduction in pump thrombosis and cerebrovascular accidents, 5 but bleeding, driveline infections, and long-term right ventricle (RV) failure continue to impair the long-term efficacy of this intervention.…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8] Patients with long-term LVAD therapy remain particularly vulnerable for RV failure, with up to 20-40% of the patients developing early RV failure 5,9,10 and 15% late RV failure. 11 Severe RV dysfunction remains the leading cause of death in the first month after LVAD implantation. 12,13 There is a growing clinical demand for physicians to have better ways to predict response to treatment as well as tailor clinical management in these patients.…”

Section: Introductionmentioning

confidence: 99%

Design and rationale of haemodynamic guidance with CardioMEMS in patients with a left ventricular assist device: the HEMO‐VAD pilot study

et al. 2019

View full text Add to dashboard Cite

AimsWe aim to study the feasibility and clinical value of pulmonary artery pressure monitoring with the CardioMEMS™ device in order to optimize and guide treatment in patients with a HeartMate 3 left ventricular assist device (LVAD).Methods and resultsIn this single‐centre, prospective pilot study, we will include 10 consecutive patients with New York Heart Association Class IIIb or IV with Interagency Registry for Mechanically Assisted Circulatory Support Classes 2–5 scheduled for implantation of a HeartMate 3 LVAD. Prior to LVAD implantation, patients will receive a CardioMEMS sensor, for daily pulmonary pressure readings. The haemodynamic information provided by the CardioMEMS will be used to improve haemodynamic status prior to LVAD surgery and optimize the timing of LVAD implantation. Post‐LVAD implantation, the haemodynamic changes will be assessed for additive value in detecting potential complications in an earlier stage (bleeding and tamponade). During the outpatient clinic phase, we will assess whether the haemodynamic feedback can optimize pump settings, detect potential complications, and further tailor the clinical management of these patients.ConclusionsThe HEMO‐VAD study is the first prospective pilot study to explore the safety and feasibility of using CardioMEMS for optimization of LVAD therapy with additional (remote) haemodynamic information.

show abstract

“…In fact, in some patients with bi-VAD support, RVAD flow was appropriately adjusted with reference of real-time changes in LS, and the effects of medical therapy was judged by the decrease in this parameter in daily practice. Moreover, late-onset RVF, or developing aortic insufficiency, has been associated with morbidity or mortality after LVAD implantation, which would worsen the cardiac loading condition [19, 20]. Routine assessment of LS after LVAD implantation may enable the earlier detection of changes in cardiac loading condition, suggesting that this technology may also work as a useful tool to manage patients before and after LVAD implantation.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of right ventricular function using liver stiffness in patients with left ventricular assist device†

Koibuchi

Toda

Nakamura

et al. 2017

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

OBJECTIVES: Although right ventricular failure (RVF) is a major concern after left ventricular assist device (LVAD) implantation, methodologies to evaluate RV function remain limited. Liver stiffness (LS), which is closely related to right-sided filling pressure and may indicate RVF severity, could be non-invasively and repeatedly assessed using transient elastography. Here we investigated the suitability of LS as a parameter of RV function in pre- and post-LVAD periods. METHODS: The study included 55 patients with LVAD implantation as a bridge to transplantation between 2011 and 2015 whose LS was assessed using transient elastography. RESULTS: Seventeen patients presented with RVF, defined as requiring inotropic support for ≥30 days, nitric oxygen inhalation for ≥5 days, and/or mechanical RV support following LVAD implantation. Survival of patients with RVF was significantly worse compared with that of patients without RVF. Multivariate logistic regression analysis identified preoperative LS, LV diastolic dimension, RV stroke work index, and dilated phase of hypertrophic cardiomyopathy aetiology as significant risk factors; the combination of these parameters could improve predictive power of post-LVAD RVF with areas under the curve of 0.89. Furthermore, LS was significantly decreased by LV unloading and significantly correlated with right-sided filling pressure. CONCLUSIONS: In addition to dilated hypertrophic cardiomyopathy aetiology, reduced RV stroke work index and small LV dimension, we demonstrated that non-invasively measured LS was a predictor of post-LVAD RVF and can be used as a parameter for the evaluation and optimization of RV function in the perioperative period.

show abstract

Incidence and clinical significance of late right heart failure during continuous-flow left ventricular assist device support

Abstract: Late RHF is common after continuous-flow LVAD implantation, but does not affect survival during LVAD support. However, it is associated with worse overall outcomes in the BTT population.

Cited by 130 publications

References 24 publications

Clinical implications of hemodynamic assessment during left ventricular assist device therapy

Clinical implications of hemodynamic assessment during left ventricular assist device therapy

Design and rationale of haemodynamic guidance with CardioMEMS in patients with a left ventricular assist device: the HEMO‐VAD pilot study

Evaluation of right ventricular function using liver stiffness in patients with left ventricular assist device†

Contact Info

Product

Resources

About