Format

Send to

Choose Destination
JACC Heart Fail. 2013 Apr;1(2):127-34. doi: 10.1016/j.jchf.2013.01.007. Epub 2013 Apr 1.

Mechanical circulatory support for right ventricular failure.

Author information

1
The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts. Electronic address: Nkapur@tuftsmedicalcenter.org.
2
The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts.
3
Interventional Cardiology, Medical University of South Carolina, Charleston, South Carolina.
4
Interventional Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
5
Division of Cardiology, Medstar Heart Institute, Washington, DC.
6
Interventional Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania.
7
Cardiology, St. Francis Hospital, Roslyn, New York.
8
Interventional Cardiology, Northwestern University, Chicago, Illinois.
9
Division of Cardiology, Oregon Health Sciences University, Portland, Oregon.

Abstract

OBJECTIVES:

The aim of this study was to explore the clinical utility of a commercially available centrifugal flow pump as a centrifugal flow-right ventricular support device (CF-RVSD) in patients with right ventricular failure (RVF).

BACKGROUND:

RVF is associated with high in-hospital mortality. Limited data regarding efficacy of the CF-RVSD for RVF exist.

METHODS:

We retrospectively reviewed data from 46 patients receiving a CF-RVSD for RVF from a registry comprising data from 8 tertiary-care hospitals in the United States. CF-RVSD use was recorded in the setting of acute myocardial infarction; myocarditis; chronic left heart failure; after valve surgery, orthotopic heart transplantation, left ventricular assist device surgery, coronary bypass grafting. Devices were implanted via the percutaneous (n = 22) or surgical (n = 24) route.

RESULTS:

No intraprocedural mortality was observed. Mean time from admission to CF-RVSD implantation was 5.7 ± 8.5 days, with a mean of 6,769 ± 789 rotations/min, providing 4.2 ± 1.3 l/min of flow. Mean duration of support was 5.4 ± 5.1 days. Mean arterial pressure (65 ± 12 mm Hg vs. 73 ± 14 mm Hg; p < 0.05), right atrial pressure (21 ± 8 mm Hg vs. 16 ± 7 mm Hg; p = 0.05), pulmonary artery systolic pressure (43 ± 15 mm Hg vs. 33 ± 15 mm Hg; p = 0.01), and cardiac index (1.7 ± 0.7 vs. 2.2 ± 0.6; p = 0.01) were improved within 48 h of CF-RVSD implantation. Total in-hospital mortality was 57% and was lowest in the setting of left ventricular assist device implantation, chronic left heart failure, and acute myocardial infarction. Increased age, biventricular failure, and Thrombolysis In Myocardial Infarction-defined major bleeding were associated with increased in-hospital mortality.

CONCLUSIONS:

Use of the CF-RVSD for RVF is clinically feasible and associated with improved hemodynamic status. Observations from the registry of patients who have received this device may support the development of prospective studies that will examine the role of percutaneous circulatory support for RVF.

KEYWORDS:

invasive hemodynamics; mechanical circulatory support; right heart failure

PMID:
24621838
DOI:
10.1016/j.jchf.2013.01.007
[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center