Concomitant triple-valve repair with durable left ventricular assist device implantation in severe right ventricle dysfunction.
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ABSTRACT:
SUBMITTER: Sicim H
PROVIDER: S-EPMC10267811 | biostudies-literature | 2023 Jun
REPOSITORIES: biostudies-literature
Publications
Concomitant triple-valve repair with durable left ventricular assist device implantation in severe right ventricle dysfunction.
Sicim Hüseyin H Pienta Michael M Tang Paul C PC
JTCVS techniques 20230302
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Project description:BackgroundA systemic right ventricle (RV) after atrial switch in transposition of the great arteries (TGA) or congenitally corrected TGA (ccTGA) often results in advanced heart failure in adulthood.Case summaryFour patients with INTERMACS Class III underwent durable ventricular assist device (VAD) implantation for a systemic RV. Two patients were diagnosed with ccTGA and underwent tricuspid valve replacement, and two were diagnosed with TGA in childhood and underwent Mustard repair. The two patients with ccTGA received an EVAHEART (Sun Medical, Nagano, Japan) and HeartMate 3 (Abbott Laboratories, Abbott Park, IL, USA) at the age of 56 years and 34 years, respectively. Of the patients with TGA, one received a Heartmate II at age 40 years, and one received a HeartMate 3 at age 40 years. All patients were weaned from cardiopulmonary bypass without subpulmonic VAD support and transferred to the intensive care unit with optimum VAD support. No in-hospital deaths, cerebrovascular accidents, or other major complications occurred. The post-VAD right heart catheter study showed a remarkable reduction in pulmonary capillary wedge pressure in all patients.DiscussionThe indications for and surgical technique of durable VAD implantation for a systemic RV after atrial switch of TGA or ccTGA have not been fully established. A durable VAD, including the HeartMate 3, was successfully implanted in four such patients in this study. Pre-operative three-dimensional computed tomography images and intraoperative transoesophageal echocardiography guidance helped to determine the positions of the inflow and pump.
| S-EPMC7891278 | biostudies-literature
Project description:There are conflicting data regarding whether concomitant mitral valve surgery (MVS) at left ventricular assist device (LVAD) implantation is beneficial. This study aimed to assess the hemodynamic effects of concomitant MVS. Of all 73 enrolled patients, 44 patients had undergone concomitant MVS and 29 patients had not. Before LVAD implantation, MVS group had higher pulmonary capillary wedge pressure (p = 0.04). After LVAD implantation, MVS group had higher mean pulmonary artery pressure and cardiac output (CO). During the hemodynamic ramp study, MVS group had steeper CO slopes (0.18 [0.13 0.28] vs. 0.15 [0.08, 0.20] L/min/step; p = 0.04) at incremental LVAD speed and achieved a higher CO at the optimized set speed (5.5 [4.7, 6.9] vs. 4.9 [4.0, 5.7] L/min; p = 0.03). One-year freedom from death or heart failure readmission was statistically comparable between the two groups (61% vs. 80%, p = 0.20). Thus far, after LVAD implantation and concomitant MVS, patients had increased pulmonary hypertension, despite having higher CO and a better response of CO at incremental LVAD speed. The implication of hemodynamic features after concomitant MVS on clinical outcomes warrants further investigation.
| S-EPMC7081836 | biostudies-literature
Project description:Systemic right ventricular failure is a common finding in patients with transposition of the great arteries. Some of these patients require ventricular assist device implantation. We describe the feasibility of HeartMate 3 [Abbott, Illinois, United States] implantation in a patient with transposition of the great arteries, high human leukocyte antigen sensitization, and severe pectus excavatum using a two-stage approach.Learning objectives1.To notice the challenges faced while implanting HeartMate 3 [Abbott, Illinois, United States] in patients with congenital heart disease and anatomical limitations.2.To understand that despite the difficulties, HeartMate 3 implantation is possible, worthwhile, and sometimes the only choice in a patient with end-stage heart failure and congenital heart disease.
| S-EPMC9352421 | biostudies-literature
Project description: Not available
| S-EPMC11845389 | biostudies-literature
Project description:ObjectivesThe main aim was a systematic evaluation of the current evidence on outcomes for patients undergoing right ventricular assist device (RVAD) implantation following left ventricular assist device (LVAD) implantation.MethodsThis systematic review was registered on PROSPERO (CRD42019130131). Reports evaluating in-hospital as well as follow-up outcome in LVAD and LVAD/RVAD implantation were identified through Ovid Medline, Web of Science and EMBASE. The primary endpoint was mortality at the hospital stay and at follow-up. Pooled incidence of defined endpoints was calculated by using random effects models.ResultsA total of 35 retrospective studies that included 3260 patients were analyzed. 30 days mortality was in favour of isolated LVAD implantation 6.74% (1.98-11.5%) versus 31.9% (19.78-44.02%) p = 0.001 in LVAD with temporary need for RVAD. During the hospital stay the incidence of major bleeding was 18.7% (18.2-19.4%) versus 40.0% (36.3-48.8%) and stroke rate was 5.6% (5.4-5.8%) versus 20.9% (16.8-28.3%) and was in favour of isolated LVAD implantation. Mortality reported at short-term as well at long-term was 19.66% (CI 15.73-23.59%) and 33.90% (CI 8.84-59.96%) in LVAD respectively versus 45.35% (CI 35.31-55.4%) p ⩽ 0.001 and 48.23% (CI 16.01-80.45%) p = 0.686 in LVAD/RVAD group respectively.ConclusionImplantation of a temporary RVAD is allied with a worse outcome during the primary hospitalization and at follow-up. Compared to isolated LVAD support, biventricular mechanical circulatory support leads to an elevated mortality and higher incidence of adverse events such as bleeding and stroke.
| S-EPMC9619248 | biostudies-literature
Project description:Number of left ventricular assist device (LVAD) implantations increases every year, particularly LVADs for destination therapy (DT). Right ventricular failure (RVF) has been recognized as a serious complication of LVAD implantation. Reported incidence of RVF after LVAD ranges from 6% to 44%, varying mostly due to differences in RVF definition, different types of LVADs, and differences in patient populations included in studies. RVF complicating LVAD implantation is associated with worse postoperative mortality and morbidity including worse end-organ function, longer hospital length of stay, and lower success of bridge to transplant (BTT) therapy. Importance of RVF and its predictors in a setting of LVAD implantation has been recognized early, as evidenced by abundant number of attempts to identify independent risk factors and develop RVF predictor scores with a common purpose to improve patient selection and outcomes by recognizing potential need for biventricular assist device (BiVAD) at the time of LVAD implantation. The aim of this article is to review and summarize current body of knowledge on risk factors and prediction scores of RVF after LVAD implantation. Despite abundance of studies and proposed risk scores for RVF following LVAD, certain common limitations make their implementation and clinical usefulness questionable. Regardless, value of these studies lies in providing information on potential key predictors for RVF that can be taken into account in clinical decision making. Further investigation of current predictors and existing scores as well as new studies involving larger patient populations and more sophisticated statistical prediction models are necessary. Additionally, a short description of our empirical institutional approach to management of RVF following LVAD implantation is provided.
| S-EPMC4295071 | biostudies-literature
Project description:Mechanical circulatory support devices are used to offer short-term support for patients with cardiogenic shock. However, these devices are not without complications, and the risk and management of each must be closely considered. We discuss an infrequent complication of the percutaneous right heart pump and review complications reported to the U.S. Food and Drug Administration. (Level of Difficulty: Intermediate.).
| S-EPMC9350931 | biostudies-literature
Project description:Patients with a systemic right ventricle (sRV) have a high risk of developing heart failure (HF), with heart transplantation as the only long-term treatment option. Unfortunately, more than half of sRV patients have pulmonary hypertension (PH) which may impact the decision to opt for heart-only transplantation. Moreover, an increased scarcity of donor hearts prolongs time to transplantation, increasing the probability of dying on the waiting list. Hence, for selected sRV patients, a ventricular assist device (VAD) could provide a solution to bridge the time to transplantation. This case series aimed at evaluating all patients with a sRV who received a VAD at our institution, with a focus on technical aspects of VAD implantation and invasive hemodynamics prior to VAD implantation and after heart transplantation. In total 5 patients with a sRV who received a VAD at our institution were included. All five were male with a median age of 38 years (19-49) at the time of VAD implantation. All patients were subsequently successfully transplanted. Pulmonary artery (PA) pressures were significantly elevated prior to VAD implantation and decreased significantly after VAD implantation and subsequent heart transplantation. With this case series we highlight the ability of a VAD to support the failing sRV, as well as to reduce PA pressures, making patients eligible for heart-only transplantation.
| S-EPMC11657773 | biostudies-literature
Project description:BackgroundLate-onset Right Ventricular (RV) failure is an established complication of Durable Left-Ventricular Assist Device (D-LVAD) implantation. Transthoracic echocardiography (TTE) remains the primary imaging modality for serial monitoring in this population, but its interpretation remains challenging due to device-related changes in RV size and function and a lack of guidelines addressing this impact. This study aims to examine the diagnostic and prognostic utility of TTE parameters of RV size and function in the detection of late-onset RV failure post-implantation.Methods and resultsA systematic literature search of medical databases was performed to identify all relevant studies assessing TTE parameters in adult patients with D-LVADs (January 2003-August 2023; English only). Of the 350 studies identified, nine studies with a pooled cohort of 627 patients and three studies with a pooled cohort of 175 patients (40 Cases and 135 controls) were meta-analyzed across a range of structural and functional TTE parameters. Compared to World Alliance Societies of Echocardiography (WASE) reference values, this population had dilated RV size (as quantified by RVEDD) and reduced systolic function (as quantified by TAPSE, RVFAC, and RVEF). TAPSE was positively associated with the non-RVF group, while RVEDD was negatively associated with the non-RVF group.ConclusionsBased on the available studies, there was baseline RV dilatation and reduced systolic function in patients with D-LVADs. Additionally, TAPSE and RVEDD demonstrated a statistically significant association with the development of RVF post-implantation, indicating a potential role as prognostic markers. Further studies should also be conducted to establish post-implantation TTE reference values.
| S-EPMC11877009 | biostudies-literature
Project description: Not available
| S-EPMC4378056 | biostudies-literature