Right Heart Failure After Left Ventricular Assist Device Implantation in Patients With Chronic Congestive Heart Failure

Dang, Nicholas C.; Topkara, V.K.; Mercando, Michelle L.; Kay, Joy; Kruger, Kurt; Aboodi, Michael S.; Öz, Mehmet C.; Naka, Yoshifumi

doi:10.1016/j.healun.2005.07.008

Cited by 456 publications

(337 citation statements)

References 20 publications

Supporting

Mentioning

320

Contrasting

Unclassified

Order By: Relevance

“…Multiple mechanisms contribute but delayed incidence of VAs is mostly secondary to pre‐existing substrate combined with a lack of favorable remodeling from the LVADs 23, 24. Sustained VAs are well tolerated by the LVAD‐supported LV, but prolonged duration of VAs can result in right ventricular dysfunction and right heart failure, which can contribute to worse outcomes in LVAD patients 25, 26. Therefore, it is common practice to continue ICD therapies following CF‐LVAD implantation and is supported by the 2013 mechanical circulatory support guidelines from the International Society of Heart and Lung Transplant 8.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Resynchronization Therapy and Clinical Outcomes in Continuous Flow Left Ventricular Assist Device Recipients

Gopinathannair

Roukoz

Bhan

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundMany patients with heart failure continue cardiac resynchronization therapy (CRT) after continuous flow left ventricular assist device (CF‐LVAD) implant. We report the first multicenter study to assess the impact of CRT on clinical outcomes in CF‐LVAD patients.Methods and ResultsAnalysis was performed on 488 patients (58±13 years, 81% male) with an implantable cardioverter defibrillator (ICD) (n=223) or CRT‐D (n=265) who underwent CF‐LVAD implantation at 5 centers from 2007 to 2015. Effects of CRT on mortality, hospitalizations, and ventricular arrhythmia incidence were compared against CF‐LVAD patients with an ICD alone. Baseline differences were noted between the 2 groups in age (60±12 versus 55±14, P<0.001) and QRS duration (159±29 versus 126±34, P=0.001). Median biventricular pacing in the CRT group was 96%. During a median follow‐up of 478 days, Kaplan–Meier analysis showed no difference in survival between groups (log rank P=0.28). Multivariate Cox regression demonstrated no survival benefit with type of device (ICD versus CRT‐D; P=0.16), whereas use of amiodarone was associated with increased mortality (hazard ratio 1.77, 95% confidence interval 1.1–2.8, P=0.01). No differences were noted between CRT and ICD groups in all‐cause (P=0.06) and heart failure (P=0.9) hospitalizations, ventricular arrhythmia incidence (43% versus 39%, P=0.3), or ICD shocks (35% versus 29%, P=0.2). During follow‐up, 69 (26%) patients underwent pulse generator replacement in the CRT‐D group compared with 36 (15.5%) in the ICD group (P=0.003).ConclusionsIn this large, multicenter CF‐LVAD cohort, continued CRT was not associated with improved survival, hospitalizations, incidence of ventricular arrhythmia and ICD therapies, and was related to a significantly higher number of pulse generator changes.

show abstract

Section: Discussionmentioning

confidence: 99%

Cardiac Resynchronization Therapy and Clinical Outcomes in Continuous Flow Left Ventricular Assist Device Recipients

Gopinathannair

Roukoz

Bhan

et al. 2018

JAHA

View full text Add to dashboard Cite

show abstract

“…PH is also a poor prognostic sign among patients undergoing advanced heart failure therapies, such as LVAD implantation. Current data suggest that RV failure post-LVAD occurs in as many as 40-50% of patients and is associated with increased mortality [6,22,23]. As such, there is growing interest in using pulmonary vasodilators as adjunctive therapy for RV dysfunction in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…Secondary PH and right ventricular (RV) dysfunction are associated with poor prognosis in HF patients in general as well as those undergoing left ventricular assist device (LVAD) implantation [5,6]. Additionally, PH is also associated with increased mortality after heart transplant and is often considered a contraindication [1,3].…”

Section: Introductionmentioning

confidence: 99%

Treatment of Secondary Pulmonary Hypertension with Bosentan after Left Ventricular Assist Device Implantation

LaRue

Garcia‐Cortes

Nassif

et al. 2015

Cardiovascular Therapeutics

View full text Add to dashboard Cite

SUMMARYIntroduction: Secondary pulmonary hypertension (PH) and right ventricular dysfunction are common and associated with poor prognosis in HF patients with left ventricular assist devices (LVADs). The role of pulmonary vasodilator therapy for these patients is currently unclear. Aims: We sought to evaluate the safety and clinical course of patients treated with bosentan, an endothelin receptor antagonist, after the implementation of a LVAD. Results: Between 10/2008 and 5/2011, 50 consecutive patients with mean PAP >25 mmHg were treated with bosentan after LVAD implantation for a mean duration of 15.7 (AE12.4) months. Ten patients discontinued the drug for possible side effects, including three for LFT abnormalities. Comparison of baseline to 6-month follow-up data revealed laboratory evidence for decongestion with a decrease in bilirubin (2.3-0.6, P < 0.0001) and an improvement in pulmonary hemodynamics with echocardiographically calculated mean PVR decreasing 1.4 woods units (3.93 AE 1.53 to 2.58 AE 1.05, P < 0.0001). Conclusion: In this single-centered retrospective case series, we provide evidence that the tolerability of bosentan in LVAD-supported patients with secondary PH is comparable to prior experience in patients with heart failure.

show abstract

“…Higher CVP has been demonstrated to be a predictor of RV failure after LVAD implantation. 20 Several authors have demonstrated that patients with RV failure had significantly higher mortality after LVAD implantation. 21, 22 Consistent with this, 5 of 8 BiVAD patients died within 1 year in our patient population due to MOF and/ or sepsis.…”

Section: Imamura T Et Almentioning

confidence: 99%

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

Imamura

Kinugawa

Shiga

et al. 2012

Circ J

View full text Add to dashboard Cite

Right Heart Failure After Left Ventricular Assist Device Implantation in Patients With Chronic Congestive Heart Failure

Cited by 456 publications

References 20 publications

Cardiac Resynchronization Therapy and Clinical Outcomes in Continuous Flow Left Ventricular Assist Device Recipients

Cardiac Resynchronization Therapy and Clinical Outcomes in Continuous Flow Left Ventricular Assist Device Recipients

Treatment of Secondary Pulmonary Hypertension with Bosentan after Left Ventricular Assist Device Implantation

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

Contact Info

Product

Resources

About