Journal article
Impact of Pre-Operative Right Ventricular Response to Hemodynamic Optimization on Outcomes in Patients with LVADs
Journal of clinical medicine, Vol.11(20), p.6111
10/17/2022
DOI: 10.3390/jcm11206111
PMCID: PMC9605231
PMID: 36294432
Abstract
Background: Right ventricular failure (RVF) continues to affect patients supported with durable left ventricular assist devices (LVAD) and results in increased morbidity and mortality. Information regarding the impact of right ventricular response to pre-operative optimization on outcomes is scarce. Methods: Single-center retrospective analysis of consecutive patients who underwent first continuous flow LVAD implantation between 2006 and 2020. Patients with bi-ventricular support before LVAD or without hemodynamic data were excluded. Invasive hemodynamics at baseline and after pre-operative medical and/or temporary circulatory support were recorded. Patients were grouped in the following categories: A: No Hemodynamic RV dysfunction (RVD) at baseline; B: RVD with achievement of RV hemodynamic optimization goals; C: RVD without achievement of RV optimization goals. The main outcomes were right ventricular failure defined as inotropes >14 days after implantation, or postoperative right ventricular mechanical support, and all-cause mortality. Results: Overall, 128 patients were included in the study. The mean age was 58 ± 12.5 years, 74.2% were males and, 68.7% had non-ischemic cardiomyopathy. Hemodynamic RVD was present in 70 (54.7%) of the patients at baseline. RV hemodynamic goals were achieved in 46 (79.31%) patients with RVD and in all the patients without RVD at baseline. Failure to achieve hemodynamic optimization goals was associated with a significantly higher risk of RVF after LVAD implantation (adjusted OR 4.37, 95% CI 1.14–16.76,
p
= 0.031) compared with no RVD at baseline and increased 1-year mortality compared with no RVD (adjusted HR 4.1, 95% CI 1.24–13.2,
p
= 0.02) and optimized RVD (adjusted HR 6.4, 95% CI 1.6–25.2,
p
= 0.008).Conclusion: Among patients with RVD, the inability to achieve hemodynamic optimization goals was associated with higher rates of RV failure and increased 1-year all-cause mortality post LVAD implantation.
Details
- Title: Subtitle
- Impact of Pre-Operative Right Ventricular Response to Hemodynamic Optimization on Outcomes in Patients with LVADs
- Creators
- Ernesto Ruiz Duque - University of Iowa Hospitals and ClinicsPaulino Alvarez - University of IowaYingchi Yang - Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287, USAMuhammad Khalid - University of IowaRupesh Kshetri - University of IowaIlias P. Doulamis - Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287, USAAnthony Panos - University of IowaAlexandros Briasoulis - Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287, USA
- Resource Type
- Journal article
- Publication Details
- Journal of clinical medicine, Vol.11(20), p.6111
- DOI
- 10.3390/jcm11206111
- PMID
- 36294432
- PMCID
- PMC9605231
- NLM abbreviation
- J Clin Med
- ISSN
- 2077-0383
- eISSN
- 2077-0383
- Publisher
- MDPI
- Language
- English
- Date published
- 10/17/2022
- Academic Unit
- Cardiovascular Medicine; General Internal Medicine; Cardiothoracic Surgery; Internal Medicine
- Record Identifier
- 9984322930802771
Metrics
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