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Right Ventricular Dysfunction in Patients Undergoing Left Ventricular Assist Device Implantation: Predictors, Management, and Device Utilization

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Surgical Treatment for Advanced Heart Failure

Abstract

Right ventricular dysfunction after left ventricular assist device (LVAD) implantation is a vexing clinical problem which has a direct impact on short- and long-term outcome. This chapter reviews previously published predictors of right ventricular failure after LVAD implantation, examines the pathophysiologic basis behind right ventricular failure, and discusses strategies for mitigation. The chapter will also review how to manage right ventricular failure should it supervene.

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References

  1. Dang NC, Topkara VK, Mercando M, Kay J, Kruger KH, Aboodi MS, et al. Right heart failure after left ventricular assist device implantation in patients with chronic congestive heart failure. J Heart Lung Transplant. 2006;25:1–6.

    Article  PubMed  Google Scholar 

  2. Schenk S, McCarthy PM, Blackstone EH, Feng J, Starling RC, Navia JL, et al. Duration of inotropic support after left ventricular assist device implantation: risk factors and impact on outcome. J Thorac Cardiovasc Surg. 2006;131:447–54.

    Article  PubMed  Google Scholar 

  3. Kavarana MN, Pessin-Minsley MS, Urtecho J, Catanese KA, Flannery M, Oz MC, et al. Right ventricular dysfunction and organ failure in left ventricular assist device recipients: a continuing problem. Ann Thorac Surg. 2002;73:745–50.

    Article  PubMed  Google Scholar 

  4. Morgan JA, John R, Lee BJ, Oz MC, Naka Y. Is severe right ventricular failure in left ventricular assist device recipients a risk factor for unsuccessful bridging to transplant and post-transplant mortality. Ann Thorac Surg. 2004;77:859–63.

    Article  PubMed  Google Scholar 

  5. Ba ZF, Wang P, Koo DJ, Cioffi WG, Bland KI, Chaudry IH. Alterations in tissue oxygen consumption and extraction after trauma and hemorrhagic shock. Crit Care Med. 2000;28:2837–42.

    Article  PubMed  CAS  Google Scholar 

  6. Frazier OH, Rose EA, Oz MC, Dembitsky W, McCarthy P, Radovancevic B, et al. Multicenter clinical evaluation of the HeartMate vented electric left ventricular assist system in patients awaiting heart transplantation. J Thorac Cardiovasc Surg. 2001;122:1186–95.

    Article  PubMed  CAS  Google Scholar 

  7. Rossi M, Sganga G, Mazzone M, Valenza V, Guarneri S, Portale G, et al. Cardiopulmonary bypass in man: role of the intestine in a self-limiting inflammatory response with demonstrable bacterial translocation. Ann Thorac Surg. 2004;77:612–8.

    Article  PubMed  Google Scholar 

  8. Rietschel ET, Brade H, Holst O, Brade L, Müller-Loennies S, Mamat U, et al. Bacterial endotoxin: chemical constitution, biological recognition, host response, and immunological detoxification. Curr Top Microbiol Immunol. 1996;216:39–81.

    Article  PubMed  CAS  Google Scholar 

  9. Masai T, Sawa Y, Ohtake S, Nishida T, Nishimura M, Fukushima N, et al. Hepatic dysfunction after left ventricular mechanical assist in patients with end-stage heart failure: role of inflammatory response and hepatic microcirculation. Ann Thorac Surg. 2002;73(2):549–55.

    Article  PubMed  Google Scholar 

  10. Frazier OH, Rose EA, Macmanus Q, Burton NA, Lefrak EA, Poirier VL, et al. Multicenter clinical evaluation of the HeartMate 1000 IP left ventricular assist device. Ann Thorac Surg. 1992;53:1080–90.

    Article  PubMed  CAS  Google Scholar 

  11. Goldstein DJ, Seldomridge JA, Chen JM, Catanese KA, DeRosa CM, Weinberg AD, et al. Use of aprotinin in LVAD recipients reduces blood loss, blood use, and perioperative mortality. Ann Thorac Surg. 1995;59:1063–8.

    Article  PubMed  CAS  Google Scholar 

  12. Kormos RL, Borovetz HS, Armitage JM, Hardesty RL, Marrone GC, Griffith BP. Evolving experience with mechanical circulatory support. Ann Surg. 1991;214:471–7.

    Article  PubMed  CAS  Google Scholar 

  13. Kormos RL, Gasior TA, Kawai A, Pham SM, Murali S, Hattler BG, et al. Transplant candidate’s clinical status rather than right ventricular function defines need for univentricular versus biventricular support. J Thorac Cardiovasc Surg. 1996;111:773–83.

    Article  PubMed  CAS  Google Scholar 

  14. Pagani FD, Lynch W, Swaniker F, Dyke DB, Bartlett R, Koelling T, et al. Extracorporeal life support to left ventricular assist device bridge to heart transplant: a strategy to optimize survival and resource utilization. Circulation. 1999;100(19 Suppl):II206–10.

    PubMed  CAS  Google Scholar 

  15. Fukamachi K, McCarthy PM, Smedira NG, Vargo RL, Starling RC, Young JB. Preoperative demographic risk factors for right ventricular failure after implantable left ventricular assist device insertion. Ann Thorac Surg. 1999;68:2181–4.

    Article  PubMed  CAS  Google Scholar 

  16. Ochiai Y, McCarthy PM, Smedira NG, Banbury MK, Navia JL, Feng J, et al. Predictors of severe right ventricular failure after implantable left ventricular assist device insertion: analysis of 245 patients. Circulation. 2002;106(12 Suppl 1):I198–202.

    PubMed  Google Scholar 

  17. Matthews JC, Koelling TM, Pagani FD, Aaronson KD. The right ventricular failure risk score a pre-operative tool for assessing the risk of right ventricular failure in left ventricular assist device candidates. J Am Coll Cardiol. 2008;51(22):2163–72.

    Article  PubMed  Google Scholar 

  18. Smedira NG, Massad MG, Navia J, Vargo RL, Patel AN, Cook DJ, et al. Pulmonary hypertension is not a risk factor for RVAD use and death after left ventricular assist system support. ASAIO J. 1996;42: M733–5.

    Article  PubMed  CAS  Google Scholar 

  19. Levin HR, Burkoff D, Chen J, Oz MC, Packer M, Rose EA. Right ventricular performance (but dot outflow resistance) is a major pre-operative determinant of right heart failure in patients with chronic heart failure who receive a left ventricular assist device. J Am Coll Cardiol. 1994;23(2 Suppl 1):838A.

    Google Scholar 

  20. Farrar DJ, Hill JD, Pennington DG, McBride LR, Holman WL, Kormos RL, et al. Preoperative and postoperative comparison of patients with univentricular and biventricular support with the Thoratec ventricular assist device as a bridge to cardiac transplantation. J Thorac Cardiovasc Surg. 1997;113:202–9.

    Article  PubMed  CAS  Google Scholar 

  21. Carvalho EM, Gabriel EA, Salerno TA. Pulmonary protection during cardiac surgery: systematic literature review. Asian Cardiovasc Thorac Ann. 2008;16: 503–7.

    Article  PubMed  Google Scholar 

  22. Loebe M, Potapov E, Sodian R, Kopitz M, Noon GP. A safe and simple method of preserving right ventricular function during implantation of a left ventricular assist device. J Thorac Cardiovasc Surg. 2001; 122(5):1043.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiac Surgery, Yale New Haven Hospital/Yale University School of Medicine, Boardman 204, 333 Cedar Street, New Haven, CT, 06510, USA

    Abeel A. Mangi

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  1. Abeel A. Mangi
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Correspondence to Abeel A. Mangi .

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Editors and Affiliations

  1. Division of Cardiothoracic Surgery, Henry Ford Hospital, West Grand Blvd. 2799, Detroit, 48202, Michigan, USA

    Jeffrey A. Morgan

  2. Department of Cardiothoracic Surgery, New York Presbyterian Hospital, Fort Washington Avenue 177, New York, 10032, New York, USA

    Yoshifumi Naka

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Mangi, A.A. (2013). Right Ventricular Dysfunction in Patients Undergoing Left Ventricular Assist Device Implantation: Predictors, Management, and Device Utilization. In: Morgan, J., Naka, Y. (eds) Surgical Treatment for Advanced Heart Failure. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6919-3_14

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  • DOI: https://doi.org/10.1007/978-1-4614-6919-3_14

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-6918-6

  • Online ISBN: 978-1-4614-6919-3

  • eBook Packages: MedicineMedicine (R0)

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