Περίληψη:
BACKGROUND: Right heart failure (RHF) is a serious post-operative
complication of left ventricular assist device (LVAD) implantation, with
significant morbidity and mortality. Many clinical, hemodynamic and
laboratory variables have been shown to have prognostic value for
appearance of RHF. We sought to investigate the incidence of new-onset
right ventricular dysfunction (RVD) complicating the long-term use of
LVADs.
METHODS: We retrospectively examined all patients supported with a
continuous-flow LVAD for >1 year at our center.
RESULTS: Twenty patients (mean age 54 +/- 10 years, 95% men, 60% with
ischemic cardiomyopathy, left ventricular ejection fraction 22 +/- 6%,
pulmonary capillary wedge pressure 23.5 +/- 7.5 mm Hg, brain natriuretic
peptide [BNP] 1,566 1,536 pg/ml, serum creatinine 1.6 +/- 0.64 mg/di,
furosemide dose 643 +/- 410 mg/day) underwent long-term mechanical
support as destination therapy support with a continuous-flow LVAD
(HeartMate IQ at our center. During follow-up (1,219 +/- 692 days), 9
patients (45%) manifested symptoms and signs of RVD (increase in right
atrial pressure [RAP], BNP and daily furosemide dose compared with the
early post-operative period). In these patients, RAP was increased by
6.6 +/- 2.6 mm Hg and BNP by 526 +/- 477 pg/ml, whereas furosemide dose
increased by 145 +/- 119 mg. The mean and median times of RVD onset were
2.3 +/- 1.5 and 2.1 years, respectively, after LVAD implantation (range
0.4 to 4.8 years). Four of these patients (44.4%) demonstrated further
deterioration of RV function and died 73 +/- 106 days (median 25 days,
range 9 to 231 days) after first manifestation of RVD. Comparisons of
baseline variables regarding medical history and clinical status did not
demonstrate significant differences between the patients with or without
RVD, including parameters related to RV function at the time of
implantation.
CONCLUSIONS: Late-onset RVD is a complication of LVAD support, which can
manifest several months to years from device implantation. This
complication has significant adverse implications with regard to patient
outcome. Prognostic factors need to be identified to follow and treat
high-risk patients more efficiently. (C) 2015 International Society for
Heart and Lung Transplantation. All rights reserved.
Συγγραφείς:
Kapelios, Chris J.
Charitos, Christos
Kaldara, Elisabeth and
Malliaras, Konstantinos
Nana, Ernmeleia
Pantsios, Christos and
Repasos, Evangelos
Tsamatsoulis, Michael.
Toumanidis, Savvas and
Nanas, John N.
