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Late-onset right ventricular dysfunction after mechanical support by a continuous-flow left ventricular assist

Chris J Kapelios1, Christos Charitos2, Elisabeth Kaldara1

  • 1Department of Cardiology, University of Athens School of Medicine, Athens.

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|July 12, 2015
PubMed
Summary

Late-onset right ventricular dysfunction (RVD) affects 45% of patients on long-term left ventricular assist device (LVAD) support. This complication significantly impacts patient outcomes and requires identification of prognostic factors for better management.

Keywords:
chronic heart failuredestination therapyleft ventricular assist devicemechanical supportright ventricular dysfunctionright ventricular failure

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Area of Science:

  • Cardiovascular Surgery
  • Heart Failure Management
  • Mechanical Circulatory Support

Background:

  • Right heart failure (RHF) is a critical post-operative complication following left ventricular assist device (LVAD) implantation, associated with high morbidity and mortality.
  • Numerous clinical, hemodynamic, and laboratory variables have demonstrated prognostic value for RHF development.
  • This study investigates the incidence of new-onset right ventricular dysfunction (RVD) during long-term LVAD support.

Purpose of the Study:

  • To determine the incidence of late-onset right ventricular dysfunction (RVD) in patients receiving continuous-flow LVADs for over one year.
  • To characterize the clinical presentation and outcomes of RVD in this patient population.

Main Methods:

  • Retrospective analysis of patients who received continuous-flow LVAD support for more than one year at a single center.
  • Evaluation of clinical parameters, right atrial pressure (RAP), brain natriuretic peptide (BNP) levels, and furosemide dosage to identify RVD.
  • Comparison of baseline characteristics between patients who developed RVD and those who did not.

Main Results:

  • Of 20 patients on long-term LVAD support, 9 (45%) developed symptoms and signs of RVD after a mean of 2.1 years post-implantation.
  • Patients with RVD showed increased right atrial pressure (RAP), brain natriuretic peptide (BNP) levels, and furosemide dosage compared to the early post-operative period.
  • No significant differences in baseline medical history or clinical status were found between patients with and without RVD.

Conclusions:

  • Late-onset RVD is a significant complication of long-term LVAD support, manifesting months to years after implantation.
  • This complication has adverse implications for patient outcomes, with a substantial mortality rate among those with RV deterioration.
  • Identification of prognostic factors is crucial for optimizing the monitoring and treatment of high-risk patients.