Critoph C.,Advanced Heart Failure and Cardiac Transplantation Royal Perth Hospital Wellington Street Perth |
Green G.,Advanced Heart Failure and Cardiac Transplantation Royal Perth Hospital Wellington Street Perth |
Hayes H.,Advanced Heart Failure and Cardiac Transplantation Royal Perth Hospital Wellington Street Perth |
Baumwol J.,Advanced Heart Failure and Cardiac Transplantation Royal Perth Hospital Wellington Street Perth |
And 3 more authors.
Right ventricular failure (RVF) is common after left ventricular assist device (LVAD) implantation and a major determinant of adverse outcomes. Optimal perioperative right ventricular (RV) management is not well defined. We evaluated the use of pulmonary vasodilator therapy during LVAD implantation. We performed a retrospective analysis of continuous-flow LVAD implants and pulmonary vasodilator use at our institution between September 2004 and June 2013. Preoperative RVF risk was assessed using recognized variables. Sixty-five patients (80% men, 50±14 years) were included: 52% HeartWare ventricular assist device (HVAD), 11% HeartMate II (HMII), 17% VentrAssist, 20% Jarvik. Predicted RVF risk was comparable with contemporary LVAD populations: 8% ventilated, 14% mechanical support, 86% inotropes, 25% BUN >39mg/dL, 23% bilirubin ≥2mg/dL, 31% RV : LV (left ventricular) diameter ≥0.75, 27% RA : PCWP (right atrium : pulmonary capillary wedge pressure) >0.63, 36% RV stroke work index <6gm-m/m2/beat. The majority (91%) received pulmonary vasodilators early and in high dose: 72% nitric oxide, 77% sildenafil (max 200±79mg/day), 66% iloprost (max 126±37μg/day). Median hospital stay was 26 (21) days. No patient required RV mechanical support. Of six (9%) patients meeting RVF criteria based on prolonged need for inotropes, four were transplanted, one is alive with an LVAD at 3 years, and one died on day 35 of intracranial hemorrhage. Two-year survival was 77% (92% for HMII/HVAD): transplanted 54%, alive with LVAD 21%, recovery/explanted 2%. A low incidence of RVF and excellent outcomes were observed for patients treated early during LVAD implantation with combination, high-dose pulmonary vasodilators. The results warrant further investigation in a randomized controlled study. © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc. Source