Survival After Left Ventricular Assist Device With and Without Temporary Right Ventricular Support

Lazar, John F.; Swartz, Michael F.; Schiralli, Matthew P.; Schneider, Marcie; Pisula, Brian; Hallinan, William; Hicks, George L.; Massey, H. Todd

doi:10.1016/j.athoracsur.2013.07.008

Cited by 56 publications

(34 citation statements)

References 8 publications

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“…Factors known to increase mortality in LVAD recipients, such as prior cardiac surgery, history of stroke, diabetes, and dialysis, were balanced across the treatment groups and within the expected range for the advanced heart failure population, and no patient received a right ventricular assist device implantation at the time of surgery. 30,38–41 …”

Section: Discussionmentioning

confidence: 99%

Mesenchymal Precursor Cells as Adjunctive Therapy in Recipients of Contemporary Left Ventricular Assist Devices

et al. 2014

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Background Allogeneic mesenchymal precursor cells (MPC) injected during left ventricular assist device (LVAD) implantation may contribute to myocardial recovery. This trial explores the safety and efficacy of this strategy. Methods and Results In this multi-center, double-blind, sham-procedure controlled trial, 30 patients were randomized (2:1) to intramyocardial injection of 25M MPCs or medium during LVAD implantation. The primary safety endpoint was incidence of infectious myocarditis, myocardial rupture, neoplasm, hypersensitivity reaction, and immune sensitization (90 days post-randomization). Key efficacy endpoints were functional status and ventricular function, while temporarily weaned from LVAD support (90 days post-randomization). Patients were followed until transplant or 12 months post-randomization, whichever came first. Mean age was 57.4 (±13.6) years, mean LVEF 18.1%, and 66.7% were destination therapy LVADs. No safety events were observed. Successful temporary LVAD weaning was achieved in 50% of MPC and 20% of control patients at 90 days (p=0.24); the posterior probability that MPCs increased the likelihood of successful weaning is 93%. At 90 days, 3 deaths occurred in control and none in MPC patients. Mean LVEF following successful wean was 24.0% (MPC=10) and 22.5% (Control=2) (p=0.56). At 12 months, 30% of MPC and 40% of control patients were successfully temporarily weaned from LVAD support (p=0.69) and 6 deaths occurred in MPC patients. Donor-specific HLA sensitization developed in 2 MPC and 3 control patients and resolved by 12 months. Conclusions In this preliminary trial, administration of MPCs appeared to be safe and there was a potential signal of efficacy. Future studies will evaluate the potential for higher or additional doses to enhance the ability to wean LVAD recipients off support. Clinical Trial Registration Information ClinicalTrials.gov. Identifier: NCT01442129.

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Section: Discussionmentioning

confidence: 99%

Mesenchymal Precursor Cells as Adjunctive Therapy in Recipients of Contemporary Left Ventricular Assist Devices

et al. 2014

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“…Patients requiring simultaneous LVAD and RVAD implantation showed less survival than those with adequate right-sided heart function because RVAD addition to a LVAD can induce complications which include technical aspects, additional bleeding sites and potential difficulties in balancing left and right flows [20,47,[59][60][61][62][63]. Planned biventricular support has better outcome than LVAD implantation followed by delayed conversion to a BVAD, and the insertion of a temporary mechanical RV support simultaneously with LVAD implantation in high-risk patients for post-operative RVF can avoid permanent BVAD support [57,[61][62][63]. Despite all improvements in medical management, temporary RV mechanical support is still required in 6% to 28% of permanent LVAD recipients with preoperative low RVF risk-scores [58,63].…”

Section: Major Intra-operative Challengesmentioning

confidence: 99%

Left ventricular vs. biventricular mechanical support: Decision making and strategies for avoidance of right heart failure after left ventricular assist device implantation

Dandel

Krabatsch

Falk

2015

International Journal of Cardiology

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“…Patients requiring simultaneous T‐RVAD following CF‐LVAD are a heterogenous group including those with acute cardiogenic shock in the immediate postimplant period and patients with acute‐on‐chronic RVF weeks or months after CF‐LVAD implant. Centrimag TMCS have been utilized for right‐sided support in both subsets of patients with hospital survival near 93% in acute‐on‐chronic RVF and 85% in acute decompensated RVF 11 . Other percutaneous options are available for right‐sided support including but not limited to Protek Duo (TandemLife, Pittsburgh, PA) and Impella RP (Abiomed, Danvers, MA), have been shown to improve right ventricular recovery and also be potential BTT options 12,13 .…”

Section: Discussionmentioning

confidence: 99%

Temporary left ventricular assist devices as a bridge to heart transplantation

et al. 2020

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Background To create equitable access to donor organs for the highest mortality patients, the cardiac transplant allocation system now prioritizes patients with surgically implanted temporary left ventricular assist devices (T‐LVADs). The outcomes following a direct bridge from a T‐LVAD to orthotopic heart transplant (OHT) are not well delineated. Aim This study investigates the T‐LVAD waitlist outcomes and compares the posttransplant outcomes in patients bridged to OHT with surgically implanted T‐LVADs to patients bridged with durable continuous‐flow left ventricular assist devices (CF‐LVADs). Methods Adults recorded in the United Network for Organ Sharing registry bridged to OHT with a durable CF‐LVAD and T‐LVADs, with or without temporary right ventricular assist devices (T‐RVADs), between 2010 and 2018 were included. Propensity matching and multivariable Cox regression were utilized to compare outcomes. Results Of 504 patients waitlisted with T‐LVADs, the majority were transplanted (50%), bridged to CF‐LVAD (17%), or recovered (9%). A total of 9047 recipients were bridged to OHT during the study period with 8875 CF‐LVADs and 172 T‐LVADs. Early survival in propensity‐matched T‐LVAD ± T‐RVAD patients was similar to CF‐LVAD ± T‐RVAD patients but reduced at a 1‐year follow‐up. This difference in survival at 1‐year follow‐up was attributable to significantly reduced survival in patients with combined T‐LVAD + T‐RVAD support when compared with CF‐LVAD, isolated T‐LVAD and combined CF‐LVAD + T‐RVAD support (80% vs 90% vs 90% vs 91%; P = .005). Conclusions This study demonstrates that most patients waitlisted with a T‐LVAD are successfully bridged to durable therapy or recover, and those bridged to OHT have acceptable posttransplant outcomes, particularly when T‐RVADs are not required.

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Survival After Left Ventricular Assist Device With and Without Temporary Right Ventricular Support

Cited by 56 publications

References 8 publications

Mesenchymal Precursor Cells as Adjunctive Therapy in Recipients of Contemporary Left Ventricular Assist Devices

Mesenchymal Precursor Cells as Adjunctive Therapy in Recipients of Contemporary Left Ventricular Assist Devices

Left ventricular vs. biventricular mechanical support: Decision making and strategies for avoidance of right heart failure after left ventricular assist device implantation

Temporary left ventricular assist devices as a bridge to heart transplantation

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