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1.
Transpl Int ; 37: 12657, 2024.
Article in English | MEDLINE | ID: mdl-38845757

ABSTRACT

This study aimed to assess the lung transplantation (LT) outcomes of patients with right ventricular dysfunction (RVD), focusing on the impact of various extracorporeal membrane oxygenation (ECMO) configurations. We included adult patients who underwent LT with ECMO as a bridge-to-transplant from 2011 to 2021 at a single center. Among patients with RVD (n = 67), veno-venous (V-V) ECMO was initially applied in 79% (53/67) and maintained until LT in 52% (35/67). Due to the worsening of RVD, the configuration was changed from V-V ECMO to veno-arterial (V-A) ECMO or a right ventricular assist device with an oxygenator (Oxy-RVAD) in 34% (18/67). They showed that lactic acid levels (2-6.1 mmol/L) and vasoactive inotropic score (6.6-22.6) increased. V-A ECMO or Oxy-RVAD was initiated and maintained until LT in 21% (14/67) of cases. There was no significant difference in the survival rates among the three configuration groups (V-V ECMO vs. configuration changed vs. V-A ECMO/Oxy-RVAD). Our findings suggest that the choice of ECMO configuration for LT candidates with RVD should be determined by the patient's current hemodynamic status. Vital sign stability supports the use of V-V ECMO, while increasing lactic acid levels and vasopressor needs may require a switch to V-A ECMO or Oxy-RVAD.


Subject(s)
Extracorporeal Membrane Oxygenation , Lung Transplantation , Ventricular Dysfunction, Right , Humans , Extracorporeal Membrane Oxygenation/methods , Male , Retrospective Studies , Female , Middle Aged , Ventricular Dysfunction, Right/therapy , Ventricular Dysfunction, Right/surgery , Adult , Treatment Outcome , Heart-Assist Devices , Aged
2.
Curr Probl Cardiol ; 49(7): 102611, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38701997

ABSTRACT

Right ventricular dysfunction (RVD) continues to be a significant contributor to both mortality and morbidity, posing a significant challenge in the management of patients undergoing evaluation for mechanical circulatory support (MCS). Currently, there is a paucity of data regarding outcomes in this subset of patients. We analyzed the National Inpatient Sample database (NIS) to identify adult hospitalizations who underwent intra-aortic balloon pump (IABP) placement with or without co-existence of RVD. Multivariate logistic regression, and linear regression analyses were used to compare outcomes, and adjust for possible confounders. Out of 126,985 hospitalizations who underwent IABP placement, 1,475 (1.2%) had RVD. Patients with RVD who received an IABP had higher adjusted odds of inpatient mortality (Adjusted odds ratio [aOR]: 2.33, 95% confidence interval [CI]: 1.7-3.2, p<0.001) than those without co-existing RVD. Hospitalized patients who underwent IABP placement with RVD had higher adjusted odds of worse hospitalization outcomes in general. Conducting additional prospective studies and clinical trials with an emphasis on further subcategorization of patients with RVD is crucial for determining optimal management strategies for these patients.


Subject(s)
Intra-Aortic Balloon Pumping , Ventricular Dysfunction, Right , Humans , Intra-Aortic Balloon Pumping/methods , Intra-Aortic Balloon Pumping/statistics & numerical data , Male , Female , Retrospective Studies , Middle Aged , Ventricular Dysfunction, Right/physiopathology , Ventricular Dysfunction, Right/therapy , United States/epidemiology , Aged , Hospital Mortality/trends , Adult , Treatment Outcome , Risk Factors
3.
Catheter Cardiovasc Interv ; 103(6): 909-916, 2024 May.
Article in English | MEDLINE | ID: mdl-38584525

ABSTRACT

BACKGROUND: Utilization of right ventricular mechanical circulatory support (RV-MCS) devices has been limited by a lack of recognition of RV failure as well as a lack of availability and experience with RV-MCS. AIMS: We report a single-center experience with the use of percutaneous RV-MCS and report predictors of adverse outcomes. METHODS: This was a single-center retrospective cohort study. Data from consecutive patients who received RV-MCS for any indication between June 2015 and January 2022 were included. Data on baseline comorbidities, hemodynamics, and laboratory values were collected. The primary outcome was in-hospital mortality analyzed as a logistic outcome in a multivariable model. These variables were further ranked by their predictive value. RESULTS: Among 58 consecutive patients enrolled, the median age was 66 years, 31% were female and 53% were white. The majority of the patients (48%) were hospitalized for acute on chronic heart failure. The majority of the patients were SCAI SHOCK Stage D (67%) and 34 (64%) patients had MCS placed within 24 h of the onset of shock. Before placement of RV-MCS, median central venous pressure (CVP) and RV stroke work index were 20 mmHg and 8.9 g m/m2, respectively. Median serum lactate was 3.5 (1.6, 6.2) mmol/L. Impella RP was implanted in 50% and ProtekDuo in the remaining 50%. Left ventricular MCS was concomitantly used in 66% of patients. Twenty-eight patients (48.3%) died. In these patients, median serum lactate was significantly higher (4.1 [2.3, 13.0] vs. 2.2 [1.4, 4.0] mmol/L, p = 0.007) and a trend toward higher median CVP (24 [18, 31] vs. 19 [14, 24] mmHg, p = 0.052). In the multivariable logistic model, both serum lactate and CVP before RV-MCS placement were independent predictors of in-hospital mortality. Serum lactate had the highest predictive value. CONCLUSION: In our real-world cohort, 52% of patients treated with RV-MCS survived their index hospitalization. Serum lactate at presentation and CVP were the strongest predictors of in-hospital mortality.


Subject(s)
Heart Failure , Heart-Assist Devices , Hospital Mortality , Recovery of Function , Ventricular Dysfunction, Right , Ventricular Function, Right , Humans , Female , Male , Retrospective Studies , Aged , Heart Failure/physiopathology , Heart Failure/mortality , Heart Failure/therapy , Heart Failure/diagnosis , Treatment Outcome , Middle Aged , Risk Factors , Time Factors , Ventricular Dysfunction, Right/physiopathology , Ventricular Dysfunction, Right/mortality , Ventricular Dysfunction, Right/etiology , Ventricular Dysfunction, Right/therapy , Ventricular Dysfunction, Right/diagnostic imaging , Risk Assessment , Prosthesis Implantation/instrumentation , Prosthesis Implantation/adverse effects , Prosthesis Implantation/mortality , Biomarkers/blood
5.
Europace ; 26(2)2024 Feb 01.
Article in English | MEDLINE | ID: mdl-38266248

ABSTRACT

BACKGROUND AND AIMS: Right bundle branch block (RBBB) and resulting right ventricular (RV) electromechanical discoordination are thought to play a role in the disease process of subpulmonary RV dysfunction that frequently occur post-repair tetralogy of Fallot (ToF). We sought to describe this disease entity, the role of pulmonary re-valvulation, and the potential added value of RV cardiac resynchronization therapy (RV-CRT). METHODS: Two patients with repaired ToF, complete RBBB, pulmonary regurgitation, and significantly decreased RV function underwent echocardiography, cardiac magnetic resonance, and an invasive study to evaluate the potential for RV-CRT as part of the management strategy. The data were used to personalize the CircAdapt model of the human heart and circulation. Resulting Digital Twins were analysed to quantify the relative effects of RV pressure and volume overload and to predict the effect of RV-CRT. RESULTS: Echocardiography showed components of a classic RV dyssynchrony pattern which could be reversed by RV-CRT during invasive study and resulted in acute improvement in RV systolic function. The Digital Twins confirmed a contribution of electromechanical RV dyssynchrony to RV dysfunction and suggested improvement of RV contraction efficiency after RV-CRT. The one patient who underwent successful permanent RV-CRT as part of the pulmonary re-valvulation procedure carried improvements that were in line with the predictions based on his Digital Twin. CONCLUSION: An integrative diagnostic approach to RV dysfunction, including the construction of Digital Twins may help to identify candidates for RV-CRT as part of the lifetime management of ToF and similar congenital heart lesions.


Subject(s)
Cardiac Resynchronization Therapy , Tetralogy of Fallot , Ventricular Dysfunction, Right , Humans , Tetralogy of Fallot/diagnostic imaging , Tetralogy of Fallot/surgery , Heart Ventricles , Echocardiography , Cardiac Resynchronization Therapy/adverse effects , Bundle-Branch Block/diagnostic imaging , Bundle-Branch Block/etiology , Bundle-Branch Block/therapy , Ventricular Dysfunction, Right/diagnostic imaging , Ventricular Dysfunction, Right/etiology , Ventricular Dysfunction, Right/therapy , Computer Simulation
6.
Crit Care Med ; 52(2): 297-306, 2024 02 01.
Article in English | MEDLINE | ID: mdl-37909826

ABSTRACT

OBJECTIVES: Concise definitive review of the use of venopulmonary arterial extracorporeal membrane oxygenation (V-PA ECMO) support in patients with cardiopulmonary failure. DATA SOURCES: Original investigations identified through a PubMed search with search terms "percutaneous right ventricular assist device," "oxy-RVAD," "V-PA ECMO," and "veno-pulmonary arterial ECMO" were reviewed and evaluated for relevance. STUDY SELECTION: Studies that included more than three patients supported with V-PA ECMO were included. DATA EXTRACTION: Clinically relevant data from included studies, including patient-important outcomes, were summarized and discussed. DATA SYNTHESIS: We identified four groups of patients where V-PA ECMO has been studied: acute respiratory distress syndrome, right ventricular dysfunction after left ventricular assist device placement, bridge to lung transplantation, and pulmonary embolism. Most identified works are small, single center, and retrospective in nature, precluding definitive conclusions regarding the efficacy of V-PA ECMO. There have been no clinical trials evaluating the efficacy of V-PA ECMO for any indication. CONCLUSIONS: V-PA ECMO is a promising form of extracorporeal support for patients with right ventricular dysfunction. Future work should focus on identifying the optimal timing and populations for the use of V-PA ECMO.


Subject(s)
Extracorporeal Membrane Oxygenation , Pulmonary Embolism , Ventricular Dysfunction, Right , Humans , Pulmonary Artery , Retrospective Studies , Ventricular Dysfunction, Right/therapy
8.
Br J Radiol ; 96(1152): 20230484, 2023 Dec.
Article in English | MEDLINE | ID: mdl-37807919

ABSTRACT

A variety of both acquired and congenital conditions can significantly affect the right ventricle, with a variety of potential origins that can have substantial clinical ramifications. These conditions can range from the impact of diseases like pulmonary arterial hypertension and ischaemic heart disease to valvular deficiencies resulting in heart failure. Moreover, the right ventricle response to factors like abnormal loading conditions, and its subsequent clinical effects, are influenced by factors such as age, disease progression, potential interventions, and their immediate and long-term clinical outcomes. Therefore, a readily available and reproducible non-invasive imaging assessment can aid in diagnosing the underlying condition of a dilated right ventricle, track its evolution, and help devising the most appropriate treatment strategy and optimal timing for its implementation throughout the patient's life.In this review, our primary focus will be on the non-invasive imaging with CT and MR of an enlarged right ventricle resulting from congenital causes and their treatment.


Subject(s)
Heart Defects, Congenital , Heart Failure , Ventricular Dysfunction, Right , Humans , Heart Ventricles/diagnostic imaging , Heart Failure/diagnosis , Heart Failure/etiology , Magnetic Resonance Imaging/adverse effects , Tomography, X-Ray Computed/adverse effects , Ventricular Dysfunction, Right/diagnostic imaging , Ventricular Dysfunction, Right/etiology , Ventricular Dysfunction, Right/therapy
9.
Semin Cardiothorac Vasc Anesth ; 27(4): 283-291, 2023 Dec.
Article in English | MEDLINE | ID: mdl-37654159

ABSTRACT

Right ventricular (RV) function is complex as a number of determinants beyond preload, inotropy and afterload play a fundamental role. In particular, arterial elastance (Ea), ventriculo-arterial coupling (VAC), and (systolic) ventricular interdependence play a vital role for the right ventricle. Understanding and actively visualizing these interactions in the failing RV as well as in the altered hemodynamic and morphological situation of left ventricular assist device (LVAD) implantation may aid clinicians in their understanding of RV dysfunction and failure. While, admittedly, hard data is scarce and invasive pressure-volume loop measurements will not become routine in cardiac surgery, we hope that clinicians will benefit from the comprehensive, simulation-based review of RV pathology. In particular, the aim of this article is to first, address and clarify the pathophysiologic hemodynamic factors that lead to RV dysfunction and then, second, expand upon this basis examining the changes occurring by LVAD implantation. This is illustrated using Harvi software which shows elastance, ventricular arterial coupling, and ventricular interdependence by simultaneously showing pressure volume loops of the right and left ventricle.


Subject(s)
Heart Failure , Heart-Assist Devices , Thoracic Surgical Procedures , Ventricular Dysfunction, Right , Humans , Hemodynamics , Heart Ventricles , Ventricular Dysfunction, Right/therapy , Ventricular Function, Right , Heart Failure/surgery
10.
Curr Heart Fail Rep ; 20(6): 471-483, 2023 Dec.
Article in English | MEDLINE | ID: mdl-37773427

ABSTRACT

PURPOSE OF REVIEW: To analyze the pathophysiologic importance of the right heart in different types of congenital heart disease (CHD), summarize current diagnostic modalities, and discuss treatment options. RECENT FINDINGS: The right ventricle (RV) plays a key role in disease progression and prognosis, either as the subpulmonary or as the systemic ventricle. Volume and/or pressure overload as well as intrinsic myocardial disease are the main factors for RV remodeling. Echocardiography and cardiac magnetic resonance imaging are important noninvasive modalities for assessing anatomy, size, and function of the right heart. Timely repair of related lesions is essential for preventing RV dysfunction. Few inconclusive data exist on conventional pharmacotherapy in CHD-related RV dysfunction. Cardiac resynchronization therapy and ventricular assist devices are an option in patients with advanced systemic RV failure. Right heart disease is highly related with adverse clinical outcomes in CHD. Research should focus on early identification of patients at risk and development of medical and interventional treatments that improve RV function.


Subject(s)
Cardiac Resynchronization Therapy , Heart Defects, Congenital , Heart Failure , Ventricular Dysfunction, Right , Humans , Heart Failure/diagnosis , Heart Failure/etiology , Heart Failure/therapy , Heart Defects, Congenital/complications , Heart Defects, Congenital/therapy , Heart Ventricles , Echocardiography/methods , Ventricular Dysfunction, Right/etiology , Ventricular Dysfunction, Right/therapy , Ventricular Function, Right/physiology
11.
Heart ; 109(24): 1844-1850, 2023 Nov 27.
Article in English | MEDLINE | ID: mdl-37527919

ABSTRACT

OBJECTIVE: A 45% threshold of right ventricular ejection fraction (RVEF) is proposed clinically relevant in patients with pulmonary arterial hypertension (PAH). We aim to determine treatment response, long-term right ventricular (RV) functional stability and prognosis of patients with PAH reaching or maintaining the RVEF 45% threshold. METHODS: Incident, treatment-naive, adult PAH patients with cardiac magnetic resonance imaging at baseline and first follow-up were included (total N=127) and followed until date of censoring or death/lung transplantation. Patients were categorised into two groups based on 45% RVEF. Baseline predictors, treatment response and prognosis were assessed with logistic regression analyses, two-way analysis of variance and log-rank tests. RESULTS: Patients were 50±17 years old, 73% female, of which N=75 reached or maintained the 45% RVEF threshold at follow-up (RVEF≥45%@FU), while N=52 patients did not (RVEF<45%@FU). RV end-diastolic volume and N-terminal pro-B-type natriuretic peptide at baseline were multivariable predictors of an RVEF ≥45% at follow-up. A 40% pulmonary vascular resistance (PVR) reduction resulted in greater improvement in RV function (ΔRVEF 17±11 vs. 5±8; pinteraction<0.001) compared to a PVR reduction <40%, but did not guarantee an RVEF ≥45%. Finally, the 45% RVEF threshold was associated with stable RV function during long-term follow-up and better survival (HR: 1.91 (95% CI: 1.11 to 3.27)). Patients failing to reach or maintain the 45% RVEF threshold at first follow-up mostly stayed below this threshold over the next consecutive visits. CONCLUSION: After treatment initiation, 60% of patients with PAH reach or maintain the 45% RVEF threshold, which is associated with a long-term stable RV function and favourable prognosis.


Subject(s)
Hypertension, Pulmonary , Pulmonary Arterial Hypertension , Ventricular Dysfunction, Right , Adult , Humans , Female , Middle Aged , Aged , Male , Pulmonary Arterial Hypertension/diagnosis , Pulmonary Arterial Hypertension/therapy , Stroke Volume/physiology , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/therapy , Hypertension, Pulmonary/complications , Ventricular Function, Right , Familial Primary Pulmonary Hypertension/complications , Ventricular Dysfunction, Right/therapy , Ventricular Dysfunction, Right/complications
13.
Semin Respir Crit Care Med ; 44(6): 762-770, 2023 12.
Article in English | MEDLINE | ID: mdl-37369216

ABSTRACT

Pulmonary arterial hypertension is a severe life-threatening condition associated with increased pulmonary vascular resistance and resulting right heart dysfunction. Admission to intensive care unit with acutely decompensated right heart failure is a significant negative prognostic event with a high risk of multisystem organ dysfunction and death. Presentations are heterogenous and may combine signs of both diastolic and systolic dysfunction complicating management. Renal dysfunction is often present, but other organ systems can be involved resulting in findings such as acute hepatic dysfunction or bowel wall congestion and ischemia. The goals of therapy are to rapidly reverse ventriculo-arterial decoupling and reduce right ventricular afterload to prevent progression to refractory or irreversible right heart failure. Triggering events must be investigated for and addressed urgently if identified. Volume status management is critical and both noninvasive and invasive testing can aid in prognostication and guide management, including the use of inotropes and vasopressors. In cases of refractory right heart dysfunction, consideration of urgent lung transplantation and mechanical circulatory support is necessary. These patients should be managed at expert centers in an intensive care setting with a multidisciplinary team of practitioners experienced in the management of right heart dysfunction given the high short- and long-term mortality resulting from acute decompensated right heart failure.


Subject(s)
Heart Failure , Hypertension, Pulmonary , Lung Transplantation , Ventricular Dysfunction, Right , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/therapy , Hypertension, Pulmonary/complications , Intensive Care Units , Lung Transplantation/adverse effects , Critical Care/methods , Heart Failure/therapy , Ventricular Dysfunction, Right/therapy , Ventricular Dysfunction, Right/etiology
14.
Curr Heart Fail Rep ; 20(3): 218-229, 2023 Jun.
Article in English | MEDLINE | ID: mdl-37155123

ABSTRACT

PURPOSE OF REVIEW: Acute right ventricular failure (RVF) is a frequent condition associated with high morbidity and mortality. This review aims to provide a current overview of the pathophysiology, presentation, and comprehensive management of acute RVF. RECENT FINDINGS: Acute RVF is a common disease with a pathophysiology that is not completely understood. There is renewed interest in the right ventricle (RV). Some advances have been principally made in chronic right ventricular failure (e.g., pulmonary hypertension). Due to a lack of precise definition and diagnostic tools, acute RVF is poorly studied. Few advances have been made in this field. Acute RVF is a complex, frequent, and life-threatening condition with several etiologies. Transthoracic echocardiography (TTE) is the key diagnostic tool in search of the etiology. Management includes transfer to an expert center and admission to the intensive care unit (ICU) in most severe cases, etiological treatment, and general measures for RVF.


Subject(s)
Heart Failure , Hypertension, Pulmonary , Ventricular Dysfunction, Right , Humans , Heart Failure/diagnosis , Heart Failure/etiology , Heart Failure/therapy , Echocardiography , Ventricular Dysfunction, Right/diagnosis , Ventricular Dysfunction, Right/etiology , Ventricular Dysfunction, Right/therapy
15.
Biomed Tech (Berl) ; 68(5): 503-510, 2023 Oct 26.
Article in English | MEDLINE | ID: mdl-37099745

ABSTRACT

OBJECTIVES: Left ventricular assist devices (LVADs) have been established as alternative to heart transplantation for patients with end-stage heart failure refractory to medical therapy. Right heart failure (RHF) after LVAD implantation is associated with inferior outcome. Its preoperative anticipation may influence the selection between a pure left ventricular and a biventricular device type and, thus, improve outcomes. Reliable algorithms to predict RHF are missing. METHODS: A numerical model was used for simulation of a cardiovascular circulation. The LVAD was placed as parallel circuit between left ventricle and aorta. In contrast to other studies, the dynamic hydraulic behavior of a pulsatile LVAD was replaced by that of a continuous LVAD. A variety of hemodynamic states was tested mimicking different right heart conditions. Adjustable parameters included heart rate (HR), pulmonary vascular resistance (PVR), tricuspid regurgitation (TR), right ventricular contractility (RVC) and pump speed. Outcome parameters comprised central venous pressure (CVP), mean pulmonary artery pressure (mPAP), cardiac output (CO) and occurrence of suction. RESULTS: Alteration of HR, PVR, TR, RVC and pump speed resulted in diverse effects on CO, CVP and mPAP, resulting in improvement, impairment or no change of the circulation, depending on the degree of alteration. CONCLUSIONS: The numerical simulation model allows prediction of circulatory changes and LVAD behaviour following variation of hemodynamic parameters. Such a prediction may be of particular advantage to anticipate RHF after LVAD implantation. It may help preoperatively to choose the appropriate strategy of only left ventricular or both left and right ventricular support.


Subject(s)
Heart Failure , Heart Transplantation , Heart-Assist Devices , Ventricular Dysfunction, Right , Humans , Heart Ventricles , Hemodynamics , Heart Failure/therapy , Retrospective Studies , Ventricular Dysfunction, Right/complications , Ventricular Dysfunction, Right/therapy
16.
Herz ; 48(4): 285-290, 2023 Aug.
Article in English | MEDLINE | ID: mdl-37079028

ABSTRACT

Right ventricular (RV) function is a critical determinant of the prognosis of patients with pulmonary hypertension (PH). Upon establishment of PH, RV dysfunction develops, leading to a gradual worsening of the condition over time, culminating in RV failure and premature mortality. Despite this understanding, the underlying mechanisms of RV failure remain obscure. As a result, there are currently no approved therapies specifically targeting the right ventricle. One contributing factor to the lack of RV-directed therapies is the complexity of the pathogenesis of RV failure as observed in animal models and clinical studies. In recent years, various research groups have begun utilizing multiple models, including both afterload-dependent and afterload-independent models, to investigate specific targets and pharmacological agents in RV failure. In this review, we examine various animal models of RV failure and the recent advancements made utilizing these models to study the mechanisms of RV failure and the potential efficacy of therapeutic interventions, with the ultimate goal of translating these findings into clinical practice to enhance the management of individuals with PH.


Subject(s)
Heart Failure , Hypertension, Pulmonary , Ventricular Dysfunction, Right , Animals , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/therapy , Heart Failure/therapy , Heart Failure/etiology , Heart Ventricles , Models, Theoretical , Ventricular Dysfunction, Right/diagnosis , Ventricular Dysfunction, Right/etiology , Ventricular Dysfunction, Right/therapy , Ventricular Function, Right
17.
Praxis (Bern 1994) ; 112(4): 226-230, 2023.
Article in German | MEDLINE | ID: mdl-36919317

ABSTRACT

Dyspnea and Right Heart Failure Abstract. Acute right ventricular failure is a critical condition diagnosed by clinical presentation combined with echocardiography. Additional diagnostic tools including laboratory, ECG, right heart catheterization, and other imaging modalities are needed to confirm the diagnosis and determine the cause. The identification and treatment of the underlying pathology, the reduction of right ventricular afterload (if possible), optimization of preload (often diuretics, rarely volume), and hemodynamic support using vasopressors and/or inodilators are mainstays of treatment. In severe cases, special therapies and mechanical circulatory support come into play.


Subject(s)
Heart Failure , Ventricular Dysfunction, Right , Humans , Ventricular Dysfunction, Right/diagnosis , Ventricular Dysfunction, Right/etiology , Ventricular Dysfunction, Right/therapy , Heart Failure/diagnosis , Heart Failure/etiology , Heart Failure/therapy , Heart Ventricles/diagnostic imaging , Echocardiography/adverse effects , Dyspnea/etiology
18.
Hellenic J Cardiol ; 73: 61-68, 2023.
Article in English | MEDLINE | ID: mdl-36914097

ABSTRACT

Baseline right ventricular (RV) function potentially determines the response to Cardiac Resynchronization Therapy (CRT) but is not included in the current selection criteria. In this meta-analysis, we examined the value of echocardiographic indices of RV function as potential predictors of CRT outcomes in patients with standard indications for CRT. Baseline tricuspid annular plane systolic excursion was consistently higher in CRT responders, and this association appears independent of age, sex, ischemic etiology of heart failure, and baseline left ventricular ejection fraction. This proof-of-concept meta-analysis of observational data may justify a more detailed assessment of RV function as an additional component in the selection process of CRT candidates.


Subject(s)
Cardiac Resynchronization Therapy , Heart Failure , Ventricular Dysfunction, Right , Humans , Stroke Volume , Treatment Outcome , Ventricular Dysfunction, Right/therapy , Ventricular Function, Left , Ventricular Function, Right/physiology
19.
J Crit Care ; 75: 154274, 2023 06.
Article in English | MEDLINE | ID: mdl-36764115

ABSTRACT

While mechanical ventilation practices on venovenous extracorporeal membrane oxygenation (VV ECMO) are variable, most institutions utilize a lung rest strategy utilizing relatively low positive end-expiratory pressure (PEEP). The effect of PEEP titration using esophageal manometry during VV ECMO on pulmonary and cardiac function is unknown. This was a retrospective study of 69 patients initiated on VV ECMO between March 2020 through November 2021. Patients underwent standard PEEP (typically 10 cm H2O) or optimal PEEP (PEEP titrated to an end-expiratory transpulmonary pressure 0-3 cm H2O) throughout the ECMO run. The optimal PEEP strategy had higher levels of applied PEEP (17.9 vs. 10.8 cm H2O on day 2 of ECMO), decreased incidence of hemodynamically significant RV dysfunction (4.55% vs. 44.0%, p = 0.0001), and higher survival to decannulation (72.7% vs. 44.0%, p = 0.022). Survival to discharge did not reach statistical significance (61.4% vs. 44.0%, p = 0.211). In univariate logistic regression analysis, optimal PEEP was associated with less hemodynamically significant RV dysfunction with an odds ratio (OR) of 0.06 (95% confidence interval [CI] = 0.01-0.27, p = 0.0008) and increased survival to decannulation with an OR of 3.39 (95% CI 1.23-9.79), p = 0.02), though other confounding factors may have contributed.


Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , Respiratory Distress Syndrome , Ventricular Dysfunction, Right , Humans , Retrospective Studies , Extracorporeal Membrane Oxygenation/adverse effects , Ventricular Dysfunction, Right/therapy , Ventricular Dysfunction, Right/complications , COVID-19/therapy , COVID-19/complications , Positive-Pressure Respiration/adverse effects
20.
Perfusion ; 38(1_suppl): 59-67, 2023 05.
Article in English | MEDLINE | ID: mdl-36597024

ABSTRACT

INTRODUCTION: Acute right ventricular failure (aRVF) is associated with high mortality and morbidity. Mechanical circulatory support (MCS) may be considered as an advanced treatment option. The ProtekDuo is a cannula that can be used to provide acute right ventricular support as part of a temporary percutaneous (tp) right ventricular assist device (RVAD) system. The primary objective of this systematic review is to describe patient survival and complications when the ProtekDuo cannula was used as part of an tpRVAD system. METHODS: MEDLINE, Embase, and Scopus were searched from database inception to August 26, 2022. Reference sections of studies were reviewed to screen for database omissions. RESULTS: Seven studies with 127 patients were eligible for inclusion. The studies included patients with aRVF from a variety of causes. Mean duration of support was between 10 and 58 days in five studies. Patient survival to discharge was between 60% and 85.2% in two studies. Four authors reported 30-day survival between 60% and 85.2%. Devicerelated and non-device related complications were low. CONCLUSIONS: Patients treated with RVAD using the ProtekDuo cannula have comparable survival rates and complications to other tpRVAD systems. Several advantages exist compared to other RVAD systems.


Subject(s)
Heart Failure , Heart-Assist Devices , Ventricular Dysfunction, Right , Humans , Cannula , Retrospective Studies , Treatment Outcome , Heart Failure/etiology , Heart-Assist Devices/adverse effects , Ventricular Dysfunction, Right/etiology , Ventricular Dysfunction, Right/therapy
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