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Clinical experience with temporary right ventricular mechanical circulatory support.

Jay K Bhama1, Utsav Bansal2, Daniel G Winger3

  • 1Division of Cardiothoracic Surgery, University of Iowa Health Care, Iowa City, Iowa.

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|June 5, 2018
PubMed
Summary

Temporary right ventricular mechanical support shows better outcomes for left ventricular assist device patients. Post-cardiotomy cardiogenic shock patients have poorer outcomes and require cautious weaning from support.

Keywords:
CentriMagLVADMCSRVFcardiogenic shockheart transplant

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Area of Science:

  • Cardiology
  • Mechanical Circulatory Support
  • Cardiac Surgery

Background:

  • Temporary right ventricular mechanical circulatory support is crucial for patients with severe cardiac conditions.
  • Indications for support include postcardiotomy cardiogenic shock, cardiac transplant, and left ventricular assist device (LVAD) placement.

Purpose of the Study:

  • To evaluate the impact of the indication for temporary right ventricular mechanical support on patient outcomes.
  • To compare survival and device weaning rates across different patient groups.

Main Methods:

  • Retrospective review of 80 patients receiving temporary right ventricular assist device (RVAD).
  • Data collected from a prospectively maintained database.
  • Kaplan-Meier survival analysis and multivariate regression were used to analyze outcomes and identify risk factors.

Main Results:

  • Successful weaning rates varied: 46% for postcardiotomy cardiogenic shock, 84% for cardiac transplant, and 83% for LVAD.
  • Survival was significantly worse for postcardiotomy cardiogenic shock patients compared to LVAD patients.
  • Immediate support improved 3-month survival (79% vs. 46%, P=.003). Post-postcardiotomy cardiogenic shock was an independent negative predictor of weaning (OR, 0.161; P=.007).

Conclusions:

  • Temporary RVAD is effective post-LVAD placement, with immediate support enhancing short-term survival.
  • Caution is advised when weaning RVAD in postcardiotomy cardiogenic shock due to poor outcomes.
  • Survival rates have remained static over time, irrespective of implant era.