Effects of a percutaneous mechanical circulatory support device for medically refractory right ventricular failure

Navin K. Kapur, Vikram Paruchuri, Ravikiran Korabathina, Ramzi Al-Mohammdi, James Mudd, Jordan Prutkin, Michele Esposito, Ameer Shah, Michael S. Kiernan, Candice Sech, Duc Thinh Pham, Marvin A. Konstam, David Denofrio

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    Abstract

    Background: Medically refractory right ventricular failure (MR-RVF) is associated with high in-hospital mortality and is managed with surgical assist devices, atrial septostomy, or extracorporeal membrane oxygenation. This study explored the hemodynamic effect associated with a percutaneous RV support device (pRVSD) for MR-RVF. Methods: Between 2008 and 2010, 9 patients with MR-RVF, defined as cardiogenic shock despite maximal medical therapy, were treated with a pRVSD. Medical records were reviewed for demographics, hemodynamic and laboratory data, and details of pRVSD implantation. Results: MR-RVF was due to severe sepsis in 1 patient (11.1%), post-cardiotomy syndrome in 2 (22.2%), and acute inferior wall myocardial infarction (IWMI) in 6 (66.7%). Five patients underwent right internal jugular-to-femoral cannulation, and 4 required bifemoral cannulation. No intra-procedural deaths or major vascular complications requiring surgical or peripheral intervention occurred. Time from admission to pRVSD implantation was 2.9 ± 3.3 days, with an average of 6516 ± 698 rotations/min, providing flow at 3.3 ± 0.4 liters/min. Mean duration of pRVSD activation was 3.1 ± 1.8 days. Compared with pre-procedural values, mean arterial pressure (57 ± 7 vs 75 ± 19 mm Hg, p <0.05), right atrial pressure (22 ± 3 vs 15 ± 6 mm Hg, p <0.05), cardiac index (1.5 ± 0.4 vs 2.3 ± 0.5 liters/min/m 2, p <0.05), mixed venous oxygen saturation (40 ± 14 vs 58 ± 4 percent, p <0.05), and RV stroke work (3.4 ± 3.9 vs 9.7 ± 6.8 g · m/beat, p <0.05) improved significantly within 24 hours of pRVSD implantation. In-hospital mortality was 44% (n = 4). Time from admission to pRVSD placement was lower in patients who survived to hospital discharge (0.9 ± 0.8 days) vs non-survivors (4.8 ± 3.5 days; p = 0.04). All survivors presented with IWMI. Conclusion: Use of a pRVSD for MR-RVF is feasible and associated with improved hemodynamics. Algorithms promoting earlier pRVSD use in MR-RVF warrant further investigation.

    Original languageEnglish (US)
    Pages (from-to)1360-1367
    Number of pages8
    JournalJournal of Heart and Lung Transplantation
    Volume30
    Issue number12
    DOIs
    StatePublished - Dec 2011

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    Equipment and Supplies
    Inferior Wall Myocardial Infarction
    Hemodynamics
    Hospital Mortality
    Catheterization
    Extracorporeal Membrane Oxygenation
    Atrial Pressure
    Cardiogenic Shock
    Patient Rights
    Thigh
    Medical Records
    Blood Vessels
    Survivors
    Sepsis
    Arterial Pressure
    Neck
    Stroke
    Demography
    Oxygen

    Keywords

    • invasive hemodynamics
    • mechanical circulatory support
    • right ventricle

    ASJC Scopus subject areas

    • Transplantation
    • Cardiology and Cardiovascular Medicine
    • Pulmonary and Respiratory Medicine
    • Surgery

    Cite this

    Effects of a percutaneous mechanical circulatory support device for medically refractory right ventricular failure. / Kapur, Navin K.; Paruchuri, Vikram; Korabathina, Ravikiran; Al-Mohammdi, Ramzi; Mudd, James; Prutkin, Jordan; Esposito, Michele; Shah, Ameer; Kiernan, Michael S.; Sech, Candice; Pham, Duc Thinh; Konstam, Marvin A.; Denofrio, David.

    In: Journal of Heart and Lung Transplantation, Vol. 30, No. 12, 12.2011, p. 1360-1367.

    Research output: Contribution to journalArticle

    Kapur, NK, Paruchuri, V, Korabathina, R, Al-Mohammdi, R, Mudd, J, Prutkin, J, Esposito, M, Shah, A, Kiernan, MS, Sech, C, Pham, DT, Konstam, MA & Denofrio, D 2011, 'Effects of a percutaneous mechanical circulatory support device for medically refractory right ventricular failure', Journal of Heart and Lung Transplantation, vol. 30, no. 12, pp. 1360-1367. https://doi.org/10.1016/j.healun.2011.07.005
    Kapur, Navin K. ; Paruchuri, Vikram ; Korabathina, Ravikiran ; Al-Mohammdi, Ramzi ; Mudd, James ; Prutkin, Jordan ; Esposito, Michele ; Shah, Ameer ; Kiernan, Michael S. ; Sech, Candice ; Pham, Duc Thinh ; Konstam, Marvin A. ; Denofrio, David. / Effects of a percutaneous mechanical circulatory support device for medically refractory right ventricular failure. In: Journal of Heart and Lung Transplantation. 2011 ; Vol. 30, No. 12. pp. 1360-1367.
    @article{3a1f504e49e343628f9d09ff43dc01b7,
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    abstract = "Background: Medically refractory right ventricular failure (MR-RVF) is associated with high in-hospital mortality and is managed with surgical assist devices, atrial septostomy, or extracorporeal membrane oxygenation. This study explored the hemodynamic effect associated with a percutaneous RV support device (pRVSD) for MR-RVF. Methods: Between 2008 and 2010, 9 patients with MR-RVF, defined as cardiogenic shock despite maximal medical therapy, were treated with a pRVSD. Medical records were reviewed for demographics, hemodynamic and laboratory data, and details of pRVSD implantation. Results: MR-RVF was due to severe sepsis in 1 patient (11.1{\%}), post-cardiotomy syndrome in 2 (22.2{\%}), and acute inferior wall myocardial infarction (IWMI) in 6 (66.7{\%}). Five patients underwent right internal jugular-to-femoral cannulation, and 4 required bifemoral cannulation. No intra-procedural deaths or major vascular complications requiring surgical or peripheral intervention occurred. Time from admission to pRVSD implantation was 2.9 ± 3.3 days, with an average of 6516 ± 698 rotations/min, providing flow at 3.3 ± 0.4 liters/min. Mean duration of pRVSD activation was 3.1 ± 1.8 days. Compared with pre-procedural values, mean arterial pressure (57 ± 7 vs 75 ± 19 mm Hg, p <0.05), right atrial pressure (22 ± 3 vs 15 ± 6 mm Hg, p <0.05), cardiac index (1.5 ± 0.4 vs 2.3 ± 0.5 liters/min/m 2, p <0.05), mixed venous oxygen saturation (40 ± 14 vs 58 ± 4 percent, p <0.05), and RV stroke work (3.4 ± 3.9 vs 9.7 ± 6.8 g · m/beat, p <0.05) improved significantly within 24 hours of pRVSD implantation. In-hospital mortality was 44{\%} (n = 4). Time from admission to pRVSD placement was lower in patients who survived to hospital discharge (0.9 ± 0.8 days) vs non-survivors (4.8 ± 3.5 days; p = 0.04). All survivors presented with IWMI. Conclusion: Use of a pRVSD for MR-RVF is feasible and associated with improved hemodynamics. Algorithms promoting earlier pRVSD use in MR-RVF warrant further investigation.",
    keywords = "invasive hemodynamics, mechanical circulatory support, right ventricle",
    author = "Kapur, {Navin K.} and Vikram Paruchuri and Ravikiran Korabathina and Ramzi Al-Mohammdi and James Mudd and Jordan Prutkin and Michele Esposito and Ameer Shah and Kiernan, {Michael S.} and Candice Sech and Pham, {Duc Thinh} and Konstam, {Marvin A.} and David Denofrio",
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    TY - JOUR

    T1 - Effects of a percutaneous mechanical circulatory support device for medically refractory right ventricular failure

    AU - Kapur, Navin K.

    AU - Paruchuri, Vikram

    AU - Korabathina, Ravikiran

    AU - Al-Mohammdi, Ramzi

    AU - Mudd, James

    AU - Prutkin, Jordan

    AU - Esposito, Michele

    AU - Shah, Ameer

    AU - Kiernan, Michael S.

    AU - Sech, Candice

    AU - Pham, Duc Thinh

    AU - Konstam, Marvin A.

    AU - Denofrio, David

    PY - 2011/12

    Y1 - 2011/12

    N2 - Background: Medically refractory right ventricular failure (MR-RVF) is associated with high in-hospital mortality and is managed with surgical assist devices, atrial septostomy, or extracorporeal membrane oxygenation. This study explored the hemodynamic effect associated with a percutaneous RV support device (pRVSD) for MR-RVF. Methods: Between 2008 and 2010, 9 patients with MR-RVF, defined as cardiogenic shock despite maximal medical therapy, were treated with a pRVSD. Medical records were reviewed for demographics, hemodynamic and laboratory data, and details of pRVSD implantation. Results: MR-RVF was due to severe sepsis in 1 patient (11.1%), post-cardiotomy syndrome in 2 (22.2%), and acute inferior wall myocardial infarction (IWMI) in 6 (66.7%). Five patients underwent right internal jugular-to-femoral cannulation, and 4 required bifemoral cannulation. No intra-procedural deaths or major vascular complications requiring surgical or peripheral intervention occurred. Time from admission to pRVSD implantation was 2.9 ± 3.3 days, with an average of 6516 ± 698 rotations/min, providing flow at 3.3 ± 0.4 liters/min. Mean duration of pRVSD activation was 3.1 ± 1.8 days. Compared with pre-procedural values, mean arterial pressure (57 ± 7 vs 75 ± 19 mm Hg, p <0.05), right atrial pressure (22 ± 3 vs 15 ± 6 mm Hg, p <0.05), cardiac index (1.5 ± 0.4 vs 2.3 ± 0.5 liters/min/m 2, p <0.05), mixed venous oxygen saturation (40 ± 14 vs 58 ± 4 percent, p <0.05), and RV stroke work (3.4 ± 3.9 vs 9.7 ± 6.8 g · m/beat, p <0.05) improved significantly within 24 hours of pRVSD implantation. In-hospital mortality was 44% (n = 4). Time from admission to pRVSD placement was lower in patients who survived to hospital discharge (0.9 ± 0.8 days) vs non-survivors (4.8 ± 3.5 days; p = 0.04). All survivors presented with IWMI. Conclusion: Use of a pRVSD for MR-RVF is feasible and associated with improved hemodynamics. Algorithms promoting earlier pRVSD use in MR-RVF warrant further investigation.

    AB - Background: Medically refractory right ventricular failure (MR-RVF) is associated with high in-hospital mortality and is managed with surgical assist devices, atrial septostomy, or extracorporeal membrane oxygenation. This study explored the hemodynamic effect associated with a percutaneous RV support device (pRVSD) for MR-RVF. Methods: Between 2008 and 2010, 9 patients with MR-RVF, defined as cardiogenic shock despite maximal medical therapy, were treated with a pRVSD. Medical records were reviewed for demographics, hemodynamic and laboratory data, and details of pRVSD implantation. Results: MR-RVF was due to severe sepsis in 1 patient (11.1%), post-cardiotomy syndrome in 2 (22.2%), and acute inferior wall myocardial infarction (IWMI) in 6 (66.7%). Five patients underwent right internal jugular-to-femoral cannulation, and 4 required bifemoral cannulation. No intra-procedural deaths or major vascular complications requiring surgical or peripheral intervention occurred. Time from admission to pRVSD implantation was 2.9 ± 3.3 days, with an average of 6516 ± 698 rotations/min, providing flow at 3.3 ± 0.4 liters/min. Mean duration of pRVSD activation was 3.1 ± 1.8 days. Compared with pre-procedural values, mean arterial pressure (57 ± 7 vs 75 ± 19 mm Hg, p <0.05), right atrial pressure (22 ± 3 vs 15 ± 6 mm Hg, p <0.05), cardiac index (1.5 ± 0.4 vs 2.3 ± 0.5 liters/min/m 2, p <0.05), mixed venous oxygen saturation (40 ± 14 vs 58 ± 4 percent, p <0.05), and RV stroke work (3.4 ± 3.9 vs 9.7 ± 6.8 g · m/beat, p <0.05) improved significantly within 24 hours of pRVSD implantation. In-hospital mortality was 44% (n = 4). Time from admission to pRVSD placement was lower in patients who survived to hospital discharge (0.9 ± 0.8 days) vs non-survivors (4.8 ± 3.5 days; p = 0.04). All survivors presented with IWMI. Conclusion: Use of a pRVSD for MR-RVF is feasible and associated with improved hemodynamics. Algorithms promoting earlier pRVSD use in MR-RVF warrant further investigation.

    KW - invasive hemodynamics

    KW - mechanical circulatory support

    KW - right ventricle

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