PMID- 34843696
OWN - NLM
STAT- MEDLINE
DCOM- 20220727
LR  - 20220801
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 114
IP  - 2
DP  - 2022 Aug
TI  - Strategies for Mechanical Right Ventricular Support During Left Ventricular 
      Assist Device Implant.
PG  - 484-491
LID - S0003-4975(21)01979-2 [pii]
LID - 10.1016/j.athoracsur.2021.10.032 [doi]
AB  - BACKGROUND: Refractory right ventricular failure at the time of left ventricular 
      assist device implantation requires treatment with supplemental mechanical 
      circulatory support. However, the optimal strategy for support remains unknown. 
      METHODS: All patients undergoing first-time durable left ventricular assist 
      device implantation with a contemporary device were selected from The Society of 
      Thoracic Surgeons National Database (2011 to 2019). Patients requiring right 
      ventricular assist device (RVAD) or venoarterial extracorporeal membrane 
      oxygenation (VA-ECMO) were included in the analysis. Patients were stratified by 
      RVAD or VA-ECMO and by timing of placement (intraoperative vs postoperative). 
      RESULTS: In all, 18 423 left ventricular assist device implants were identified, 
      of which 940 (5.1%) required RVAD (n = 750) or VA-ECMO (n = 190) support. 
      Patients receiving an RVAD more frequently had preoperative inotrope requirement 
      (76% vs 62%, P < .01) and severe tricuspid regurgitation (20% vs 13%, P < .01). 
      The RVAD patients had lower rates of postoperative renal failure (40% vs 51%, P = 
      .02) and limb ischemia (4% vs 13%, P < .01), as well as significantly less 
      operative mortality (41% vs 54%, P < .01). After risk adjustment with propensity 
      score analysis, support with VA-ECMO was associated with a higher risk of 
      mortality (risk ratio 1.46; 95% confidence interval, 1.21 to 1.77; P < .01) 
      compared with patients receiving an RVAD. Importantly, institution of right 
      ventricular support postoperatively was associated with higher mortality (1.43, P 
      < .01) compared with intraoperative initiation. CONCLUSIONS: Patients with severe 
      right ventricular failure in the setting of durable left ventricular assist 
      device implantation may benefit from the use of RVAD over VA-ECMO. Regardless of 
      the type of support, initiation at the index operation was associated with 
      improved outcomes.
CI  - Copyright (c) 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All 
      rights reserved.
FAU - Beller, Jared P
AU  - Beller JP
AD  - Division of Cardiac Surgery, Department of Surgery, University of Virginia, 
      Charlottesville, Virginia.
FAU - Mehaffey, J Hunter
AU  - Mehaffey JH
AD  - Division of Cardiac Surgery, Department of Surgery, University of Virginia, 
      Charlottesville, Virginia.
FAU - Wegermann, Zachary K
AU  - Wegermann ZK
AD  - Duke Clinical Research Institute, Duke University, Durham, North Carolina.
FAU - Grau-Sepulveda, Maria
AU  - Grau-Sepulveda M
AD  - Duke Clinical Research Institute, Duke University, Durham, North Carolina.
FAU - O'Brien, Sean M
AU  - O'Brien SM
AD  - Duke Clinical Research Institute, Duke University, Durham, North Carolina.
FAU - Brennan, J Matthew
AU  - Brennan JM
AD  - Duke Clinical Research Institute, Duke University, Durham, North Carolina.
FAU - Thourani, Vinod
AU  - Thourani V
AD  - Piedmont Heart Institute, Atlanta, Georgia.
FAU - Badhwar, Vinay
AU  - Badhwar V
AD  - Department of Cardiovascular and Thoracic Surgery, West Virginia University Heart 
      and Vascular Center, Morgantown, West Virginia.
FAU - Pagani, Francis D
AU  - Pagani FD
AD  - Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
FAU - Ailawadi, Gorav
AU  - Ailawadi G
AD  - Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
FAU - Yarboro, Leora T
AU  - Yarboro LT
AD  - Division of Cardiac Surgery, Department of Surgery, University of Virginia, 
      Charlottesville, Virginia.
FAU - Teman, Nicholas R
AU  - Teman NR
AD  - Division of Cardiac Surgery, Department of Surgery, University of Virginia, 
      Charlottesville, Virginia. Electronic address: nrt4c@virginia.edu.
LA  - eng
PT  - Journal Article
DEP - 20211126
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
CIN - Ann Thorac Surg. 2022 Aug;114(2):491. PMID: 34838738
MH  - *Extracorporeal Membrane Oxygenation
MH  - *Heart Failure/surgery
MH  - *Heart-Assist Devices
MH  - Humans
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - *Ventricular Dysfunction, Right
EDAT- 2021/11/30 06:00
MHDA- 2022/07/28 06:00
CRDT- 2021/11/29 20:11
PHST- 2021/02/09 00:00 [received]
PHST- 2021/09/20 00:00 [revised]
PHST- 2021/10/11 00:00 [accepted]
PHST- 2021/11/30 06:00 [pubmed]
PHST- 2022/07/28 06:00 [medline]
PHST- 2021/11/29 20:11 [entrez]
AID - S0003-4975(21)01979-2 [pii]
AID - 10.1016/j.athoracsur.2021.10.032 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2022 Aug;114(2):484-491. doi: 10.1016/j.athoracsur.2021.10.032. 
      Epub 2021 Nov 26.