Rescuing the right ventricle: A conceptual framework to target new interventions for patients receiving a durable left ventricular assist device

Bitar, Abbas; Likosky, Donald S.; Pagani, Francis D.; Ela, Ashraf Shaaban Abdel Aziz Abou El; Tang, Paul C.; Thompson, Michael P.; Hawkins, Robert B.; Sassalos, Peter; Noly, Pierre‐Emmanuel; Aaronson, Keith D.; Shore, Supriya; Cascino, Thomas; Zhang, Min; McCullough, Jeffrey S.; Chung, Grace H.; Hou, Michelle; Janda, Allison M.; Mathis, Michael R.; Watt, Tessa M.F.; Pienta, Michael J.; Brescia, Alexander A.; Yost, Gardner; Stewart, James; Airhart, Austin; Liesman, Daniel; Nassar, Khalil

doi:10.1016/j.jtcvs.2022.03.025

Cited by 3 publications

(3 citation statements)

References 25 publications

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“…The importance of congestion and central venous pressure to kidney function in heart failure is widely recognized, and there are several potential mechanisms underlying this [33]. This is particularly relevant for LVAD recipients, as right heart failure (RHF) after LVAD implantation is a common and feared complication, affecting up to 40% of recipients [34]. Recent studies have investigated the diversity of RHF after LVAD implantation, which can vary in terms of timing of onset (early or late after LVAD implantation, often dichotomized at a 30-day time point), and in terms of persistence of the RHF [35].…”

Section: Kidney Dysfunction and Right Heart Failure After Left Ventri...mentioning

confidence: 99%

Kidney health and function with left ventricular assist devices

Garcia

Walther

2023

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of reviewMechanical circulatory support (MCS) is a group of evolving therapies used for indications ranging from temporary support during a cardiac procedure to permanent treatment of advanced heart failure. MCS is primarily used to support left ventricle function, in which case the devices are termed left ventricular assist devices (LVADs). Kidney dysfunction is common in patients requiring these devices, yet the impact of MCS itself on kidney health in many settings remains uncertain.Recent findingsKidney dysfunction can manifest in many different forms in patients requiring MCS. It can be because of preexisting systemic disorders, acute illness, procedural complications, device complications, and long-term LVAD support. After durable LVAD implantation, most persons have improvement in kidney function; however, individuals can have markedly different kidney outcomes, and novel phenotypes of kidney outcomes have been identified.SummaryMCS is a rapidly evolving field. Kidney health and function before, during, and after MCS is relevant to outcomes from an epidemiologic perspective, yet the pathophysiology underlying this is uncertain. Improved understanding of the relationship between MCS use and kidney health is important to improving patient outcomes.

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Section: Kidney Dysfunction and Right Heart Failure After Left Ventri...mentioning

confidence: 99%

Kidney health and function with left ventricular assist devices

Garcia

Walther

2023

Current Opinion in Nephrology &Amp; Hypertension

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“…Rescuing the right ventricle, this is the need and the challenge in cardiac surgery, particularly left ventricular assist device (LVAD) implantation. As Pienta and colleagues 1 state in this month's edition of the Journal, right heart failure (RHF) is a frequent comorbid condition in patients in need of LVADs. Indeed, RHF is an ever-looming menace in cardiac surgery overall, and the systemic perturbation of multiple homeostatic pathways that occurs because of RHF can lead to perioperative struggles and poor outcomes.…”

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confidence: 99%

Commentary: Can we get it right?

Whitson

2023

The Journal of Thoracic and Cardiovascular Surgery

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“…The development of RHF after LVAD is likely polymechanistic and via various anatomic, mechanical, physiologic, and inflammatory pathways. 3,4 It is clear that preimplant right ventricular function alone is only very modestly associated with postimplant RHF. 5 In a host as complicated as an advanced heart failure patient, a myriad of preimplant, intraoperative, and postoperative factors potentially interact together and contribute to the development of RHF.…”

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confidence: 99%

Explainable Machine Learning Analysis of Right Heart Failure After Left Ventricular Assist Device Implantation

et al. 2022

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Right heart failure (RHF) remains a common and serious complication after durable left ventricular assist device (LVAD) implantation. We used explainable machine learning (ML) methods to derive novel insights into preimplant patient factors associated with RHF. Continuous-flow LVAD implantations from 2008 to 2017 in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) were included. A total of 186 preimplant patient factors were analyzed and the primary outcome was 30 days of severe RHF. A boosted decision tree ML algorithm and an explainable ML method were applied to identify the most important factors associated with RHF, nonlinear relationships and interactions, and risk inflection points. Out of 19,595 patients, 19.1% developed severe RHF at 30 days. Thirty top predictors of RHF were identified with the top five being INTERMACS profile, Model for End-stage Liver Disease score, the number of inotropic infusions, hemoglobin, and race. Many top factors exhibited nonlinear relationships with key risk inflection points such as INTERMACS profile between 2 and 3, right atrial pressure of 15 mmHg, pulmonary artery pressure index of 3, and prealbumin of 23 mg/dl. Finally, the most important variable interactions involved INTERMACS profile and the number of inotropes. These insights could help formulate patient optimization strategies prior to LVAD implantation.

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Rescuing the right ventricle: A conceptual framework to target new interventions for patients receiving a durable left ventricular assist device

Cited by 3 publications

References 25 publications

Kidney health and function with left ventricular assist devices

Kidney health and function with left ventricular assist devices

Commentary: Can we get it right?

Explainable Machine Learning Analysis of Right Heart Failure After Left Ventricular Assist Device Implantation

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