Temporary right ventricular support following left ventricle assist device implantation: a comparison of two techniques.
Détails
ID Serval
serval:BIB_FF7D0FE11DA4
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Temporary right ventricular support following left ventricle assist device implantation: a comparison of two techniques.
Périodique
Interactive cardiovascular and thoracic surgery
ISSN
1569-9285 (Electronic)
ISSN-L
1569-9285
Statut éditorial
Publié
Date de publication
07/2014
Peer-reviewed
Oui
Volume
19
Numéro
1
Pages
49-55
Langue
anglais
Notes
Publication types: Comparative Study ; Journal Article
Publication Status: ppublish
Publication Status: ppublish
Résumé
Right ventricular failure (RVF) after implantation of left ventricular assist device (LVAD) is a dramatic complication. We compared retrospectively two techniques of temporary right ventricular support after LVAD (HeartMate II, Thoratec Corp, Pleasonton, CA, USA) implantation.
From 1 January 2006 to 31 December 2012, 78 patients [mean age 52 ± 1.34 years; 15 women (19%)] received a HeartMate II at our institution. Among these, 18 patients (23%) suffered postimplant RVF treated by peripheral temporary right ventricular support. Aetiology of heart failure was ischaemic in 12 (67%) and dilated cardiomyopathy in 6 (33%) patients. The preimplant RV risk score averaged 5.1 ± 0.59. Ten patients were treated using a femorofemoral venoarterial extracorporeal life support (ECLS) and 8 patients were treated using extracorporeal membrane oxygenation as a right ventricular assist device (RVAD) established between a femoral vein and the pulmonary artery via a Dacron prosthesis (RVAD).
Duration of RV support was 7.12 ± 5.4 days and 9.57 ± 3.5 days in venoarterial ECLS and vein and the pulmonary artery RVAD groups, respectively (P = 0.32). Three patients (17%) died while under RV support (venoarterial ECLS, n = 2; and vein and the pulmonary artery RVAD, n = 1, P = 0.58). In the venoarterial ECLS group, 6 (60%) patients suffered major thromboembolic complications including thrombosis of the ECLS arterial line (n = 2), ischaemic stroke (n = 2) and thrombosis of the ascending aorta (n = 2). No major complication was observed in the vein and the pulmonary artery RVAD group (P = 0.01). RV support was successfully weaned in 8 (80%) patients of the venoarterial ECLS group and in 7 (87.5%) of the vein and the pulmonary artery RVAD group (P = 0.58). The duration of postimplant intensive care unit stay was not different (respectively, 27.5 ± 18.7 days and 20.0 ± 12.0 days; P = 0.38) between both groups.
Temporary support of the failing RV after LVAD implantation using temporary vein and the pulmonary artery RVAD is a promising therapeutic option. This approach provides adequate LVAD pre- and afterload and is associated with significantly less thromboembolic complications.
From 1 January 2006 to 31 December 2012, 78 patients [mean age 52 ± 1.34 years; 15 women (19%)] received a HeartMate II at our institution. Among these, 18 patients (23%) suffered postimplant RVF treated by peripheral temporary right ventricular support. Aetiology of heart failure was ischaemic in 12 (67%) and dilated cardiomyopathy in 6 (33%) patients. The preimplant RV risk score averaged 5.1 ± 0.59. Ten patients were treated using a femorofemoral venoarterial extracorporeal life support (ECLS) and 8 patients were treated using extracorporeal membrane oxygenation as a right ventricular assist device (RVAD) established between a femoral vein and the pulmonary artery via a Dacron prosthesis (RVAD).
Duration of RV support was 7.12 ± 5.4 days and 9.57 ± 3.5 days in venoarterial ECLS and vein and the pulmonary artery RVAD groups, respectively (P = 0.32). Three patients (17%) died while under RV support (venoarterial ECLS, n = 2; and vein and the pulmonary artery RVAD, n = 1, P = 0.58). In the venoarterial ECLS group, 6 (60%) patients suffered major thromboembolic complications including thrombosis of the ECLS arterial line (n = 2), ischaemic stroke (n = 2) and thrombosis of the ascending aorta (n = 2). No major complication was observed in the vein and the pulmonary artery RVAD group (P = 0.01). RV support was successfully weaned in 8 (80%) patients of the venoarterial ECLS group and in 7 (87.5%) of the vein and the pulmonary artery RVAD group (P = 0.58). The duration of postimplant intensive care unit stay was not different (respectively, 27.5 ± 18.7 days and 20.0 ± 12.0 days; P = 0.38) between both groups.
Temporary support of the failing RV after LVAD implantation using temporary vein and the pulmonary artery RVAD is a promising therapeutic option. This approach provides adequate LVAD pre- and afterload and is associated with significantly less thromboembolic complications.
Mots-clé
Adult, Aged, Echocardiography, Transesophageal, Extracorporeal Circulation/adverse effects, Extracorporeal Circulation/methods, Extracorporeal Circulation/mortality, Extracorporeal Membrane Oxygenation/adverse effects, Extracorporeal Membrane Oxygenation/mortality, Female, Femoral Vein/physiopathology, Femoral Vein/surgery, Heart Failure/diagnosis, Heart Failure/mortality, Heart Failure/physiopathology, Heart Failure/therapy, Heart-Assist Devices, Hospital Mortality, Humans, Male, Middle Aged, Prosthesis Design, Prosthesis Implantation/adverse effects, Prosthesis Implantation/instrumentation, Prosthesis Implantation/mortality, Pulmonary Artery/physiopathology, Pulmonary Artery/surgery, Recovery of Function, Retrospective Studies, Time Factors, Treatment Outcome, Ventricular Dysfunction, Right/diagnosis, Ventricular Dysfunction, Right/etiology, Ventricular Dysfunction, Right/mortality, Ventricular Dysfunction, Right/physiopathology, Ventricular Dysfunction, Right/therapy, Ventricular Function, Left, Ventricular Function, Right, Extracorporeal membrane oxygenation, Left ventricular assistance device, Right ventricular failure
Pubmed
Web of science
Open Access
Oui
Création de la notice
28/03/2019 17:37
Dernière modification de la notice
20/08/2019 16:29
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