Outcome of unplanned right ventricular assist device support for severe right heart failure after implantable left ventricular assist device insertion

Koji Takeda, Yoshifumi Naka, Jonathan A. Yang, Nir Uriel, Paolo C. Colombo, Ulrich P. Jorde, Hiroo Takayama

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

Background The use of a right ventricular assist device (RVAD) becomes necessary for severe right ventricular (RV) failure after left ventricular assist device (LVAD) insertion. Although temporary support could lead to successful RVAD weaning in certain patients, the data remain scarce. Methods We retrospectively reviewed 398 patients who underwent implantable LVAD insertion between January 2000 and December 2012. Of these patients, 44 (11%) required unplanned RVAD support due to severe RV failure after LVAD insertion. For comparison, 37 patients who underwent planned biventricular assist device (BiVAD) insertion were identified during the same study period. We analyzed the early and late outcomes in these patients. Results The mean duration of RVAD support was 21 ± 23 days. Of the 44 patients, 21 (49%) were weaned from the RVAD (weaning group), whereas 23 (51%) required continued biventricular support (failure group). The failure group had ongoing end-organ dysfunction after RVAD insertion. Hospital mortality was significantly lower in the weaning group (24%) and in the planned BiVAD group (30%) as compared to the failure group (74%, p = 0.0009). The 6-month actuarial survival rate was 75% in the weaning group, 62% in the planned BiVAD group and 13% in the failure group (p < 0.0001). Successful bridge to transplant was achieved in 14 patients (67%) in the weaning group as compared with 8 patients (35%) in the failure group (p = 0.03). On multivariate logistic regression analyses, pre-operative white blood cell (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.04 to 1.50, p = 0.016) and creatinine (OR 0.26, 95% CI 0.079 to 0.88, p = 0.03) levels were significant predictors for RVAD removal. Conclusions Among patients who developed acute RV failure after LVAD insertion, only half could be weaned from the temporary RVAD support. An alternative strategy is necessary in patients who require continuous RVAD support.

Original languageEnglish (US)
Pages (from-to)141-148
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume33
Issue number2
DOIs
StatePublished - Feb 2014
Externally publishedYes

Fingerprint

Heart-Assist Devices
Heart Failure
Weaning
Equipment and Supplies
Odds Ratio
Confidence Intervals
Device Removal
Hospital Mortality
Creatinine
Leukocytes

Keywords

  • heart failure
  • heart transplant
  • LVAD
  • right ventricle
  • RVAD
  • ventricular assist device

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Outcome of unplanned right ventricular assist device support for severe right heart failure after implantable left ventricular assist device insertion. / Takeda, Koji; Naka, Yoshifumi; Yang, Jonathan A.; Uriel, Nir; Colombo, Paolo C.; Jorde, Ulrich P.; Takayama, Hiroo.

In: Journal of Heart and Lung Transplantation, Vol. 33, No. 2, 02.2014, p. 141-148.

Research output: Contribution to journalArticle

Takeda, Koji ; Naka, Yoshifumi ; Yang, Jonathan A. ; Uriel, Nir ; Colombo, Paolo C. ; Jorde, Ulrich P. ; Takayama, Hiroo. / Outcome of unplanned right ventricular assist device support for severe right heart failure after implantable left ventricular assist device insertion. In: Journal of Heart and Lung Transplantation. 2014 ; Vol. 33, No. 2. pp. 141-148.
@article{905a68f959fb44b381defc30426176b5,
title = "Outcome of unplanned right ventricular assist device support for severe right heart failure after implantable left ventricular assist device insertion",
abstract = "Background The use of a right ventricular assist device (RVAD) becomes necessary for severe right ventricular (RV) failure after left ventricular assist device (LVAD) insertion. Although temporary support could lead to successful RVAD weaning in certain patients, the data remain scarce. Methods We retrospectively reviewed 398 patients who underwent implantable LVAD insertion between January 2000 and December 2012. Of these patients, 44 (11{\%}) required unplanned RVAD support due to severe RV failure after LVAD insertion. For comparison, 37 patients who underwent planned biventricular assist device (BiVAD) insertion were identified during the same study period. We analyzed the early and late outcomes in these patients. Results The mean duration of RVAD support was 21 ± 23 days. Of the 44 patients, 21 (49{\%}) were weaned from the RVAD (weaning group), whereas 23 (51{\%}) required continued biventricular support (failure group). The failure group had ongoing end-organ dysfunction after RVAD insertion. Hospital mortality was significantly lower in the weaning group (24{\%}) and in the planned BiVAD group (30{\%}) as compared to the failure group (74{\%}, p = 0.0009). The 6-month actuarial survival rate was 75{\%} in the weaning group, 62{\%} in the planned BiVAD group and 13{\%} in the failure group (p < 0.0001). Successful bridge to transplant was achieved in 14 patients (67{\%}) in the weaning group as compared with 8 patients (35{\%}) in the failure group (p = 0.03). On multivariate logistic regression analyses, pre-operative white blood cell (odds ratio [OR] 1.3, 95{\%} confidence interval [CI] 1.04 to 1.50, p = 0.016) and creatinine (OR 0.26, 95{\%} CI 0.079 to 0.88, p = 0.03) levels were significant predictors for RVAD removal. Conclusions Among patients who developed acute RV failure after LVAD insertion, only half could be weaned from the temporary RVAD support. An alternative strategy is necessary in patients who require continuous RVAD support.",
keywords = "heart failure, heart transplant, LVAD, right ventricle, RVAD, ventricular assist device",
author = "Koji Takeda and Yoshifumi Naka and Yang, {Jonathan A.} and Nir Uriel and Colombo, {Paolo C.} and Jorde, {Ulrich P.} and Hiroo Takayama",
year = "2014",
month = "2",
doi = "10.1016/j.healun.2013.06.025",
language = "English (US)",
volume = "33",
pages = "141--148",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
publisher = "Elsevier USA",
number = "2",

}

TY - JOUR

T1 - Outcome of unplanned right ventricular assist device support for severe right heart failure after implantable left ventricular assist device insertion

AU - Takeda, Koji

AU - Naka, Yoshifumi

AU - Yang, Jonathan A.

AU - Uriel, Nir

AU - Colombo, Paolo C.

AU - Jorde, Ulrich P.

AU - Takayama, Hiroo

PY - 2014/2

Y1 - 2014/2

N2 - Background The use of a right ventricular assist device (RVAD) becomes necessary for severe right ventricular (RV) failure after left ventricular assist device (LVAD) insertion. Although temporary support could lead to successful RVAD weaning in certain patients, the data remain scarce. Methods We retrospectively reviewed 398 patients who underwent implantable LVAD insertion between January 2000 and December 2012. Of these patients, 44 (11%) required unplanned RVAD support due to severe RV failure after LVAD insertion. For comparison, 37 patients who underwent planned biventricular assist device (BiVAD) insertion were identified during the same study period. We analyzed the early and late outcomes in these patients. Results The mean duration of RVAD support was 21 ± 23 days. Of the 44 patients, 21 (49%) were weaned from the RVAD (weaning group), whereas 23 (51%) required continued biventricular support (failure group). The failure group had ongoing end-organ dysfunction after RVAD insertion. Hospital mortality was significantly lower in the weaning group (24%) and in the planned BiVAD group (30%) as compared to the failure group (74%, p = 0.0009). The 6-month actuarial survival rate was 75% in the weaning group, 62% in the planned BiVAD group and 13% in the failure group (p < 0.0001). Successful bridge to transplant was achieved in 14 patients (67%) in the weaning group as compared with 8 patients (35%) in the failure group (p = 0.03). On multivariate logistic regression analyses, pre-operative white blood cell (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.04 to 1.50, p = 0.016) and creatinine (OR 0.26, 95% CI 0.079 to 0.88, p = 0.03) levels were significant predictors for RVAD removal. Conclusions Among patients who developed acute RV failure after LVAD insertion, only half could be weaned from the temporary RVAD support. An alternative strategy is necessary in patients who require continuous RVAD support.

AB - Background The use of a right ventricular assist device (RVAD) becomes necessary for severe right ventricular (RV) failure after left ventricular assist device (LVAD) insertion. Although temporary support could lead to successful RVAD weaning in certain patients, the data remain scarce. Methods We retrospectively reviewed 398 patients who underwent implantable LVAD insertion between January 2000 and December 2012. Of these patients, 44 (11%) required unplanned RVAD support due to severe RV failure after LVAD insertion. For comparison, 37 patients who underwent planned biventricular assist device (BiVAD) insertion were identified during the same study period. We analyzed the early and late outcomes in these patients. Results The mean duration of RVAD support was 21 ± 23 days. Of the 44 patients, 21 (49%) were weaned from the RVAD (weaning group), whereas 23 (51%) required continued biventricular support (failure group). The failure group had ongoing end-organ dysfunction after RVAD insertion. Hospital mortality was significantly lower in the weaning group (24%) and in the planned BiVAD group (30%) as compared to the failure group (74%, p = 0.0009). The 6-month actuarial survival rate was 75% in the weaning group, 62% in the planned BiVAD group and 13% in the failure group (p < 0.0001). Successful bridge to transplant was achieved in 14 patients (67%) in the weaning group as compared with 8 patients (35%) in the failure group (p = 0.03). On multivariate logistic regression analyses, pre-operative white blood cell (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.04 to 1.50, p = 0.016) and creatinine (OR 0.26, 95% CI 0.079 to 0.88, p = 0.03) levels were significant predictors for RVAD removal. Conclusions Among patients who developed acute RV failure after LVAD insertion, only half could be weaned from the temporary RVAD support. An alternative strategy is necessary in patients who require continuous RVAD support.

KW - heart failure

KW - heart transplant

KW - LVAD

KW - right ventricle

KW - RVAD

KW - ventricular assist device

UR - http://www.scopus.com/inward/record.url?scp=84893370127&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84893370127&partnerID=8YFLogxK

U2 - 10.1016/j.healun.2013.06.025

DO - 10.1016/j.healun.2013.06.025

M3 - Article

VL - 33

SP - 141

EP - 148

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

IS - 2

ER -