Mechanical circulatory support for right ventricular failure

Navin K. Kapur, Vikram Paruchuri, Anand Jagannathan, Daniel Steinberg, Anjan K. Chakrabarti, Duane Pinto, Nima Aghili, Samer Najjar, John Finley, Nicole M. Orr, Michael Tempelhof, James Mudd, Michael S. Kiernan, Duc Thinh Pham, David DeNofrio

    Research output: Contribution to journalArticle

    54 Citations (Scopus)

    Abstract

    Objectives: The aim of this study was to explore the clinical utility of a commercially available centrifugal flow pump as a centrifugal flow-right ventricular support device (CF-RVSD) in patients with right ventricular failure (RVF). Background: RVF is associated with high in-hospital mortality. Limited data regarding efficacy of the CF-RVSD for RVF exist. Methods: We retrospectively reviewed data from 46 patients receiving a CF-RVSD for RVF from a registry comprising data from 8 tertiary-care hospitals in the United States. CF-RVSD use was recorded in the setting of acute myocardial infarction; myocarditis; chronic left heart failure; after valve surgery, orthotopic heart transplantation, left ventricular assist device surgery, coronary bypass grafting. Devices were implanted via the percutaneous (n = 22) or surgical (n = 24) route. Results: No intraprocedural mortality was observed. Mean time from admission to CF-RVSD implantation was 5.7 ± 8.5 days, with a mean of 6,769 ± 789 rotations/min, providing 4.2 ± 1.3 l/min of flow. Mean duration of support was 5.4 ± 5.1 days. Mean arterial pressure (65 ± 12 mm Hg vs. 73 ± 14 mm Hg; p <0.05), right atrial pressure (21 ± 8 mm Hg vs. 16 ± 7 mm Hg; p = 0.05), pulmonary artery systolic pressure (43 ± 15 mm Hg vs. 33 ± 15 mm Hg; p = 0.01), and cardiac index (1.7 ± 0.7 vs. 2.2 ± 0.6; p = 0.01) were improved within 48 h of CF-RVSD implantation. Total in-hospital mortality was 57% and was lowest in the setting of left ventricular assist device implantation, chronic left heart failure, and acute myocardial infarction. Increased age, biventricular failure, and Thrombolysis In Myocardial Infarction-defined major bleeding were associated with increased in-hospital mortality. Conclusions: Use of the CF-RVSD for RVF is clinically feasible and associated with improved hemodynamic status. Observations from the registry of patients who have received this device may support the development of prospective studies that will examine the role of percutaneous circulatory support for RVF.

    Original languageEnglish (US)
    Pages (from-to)127-134
    Number of pages8
    JournalJACC: Heart Failure
    Volume1
    Issue number2
    DOIs
    StatePublished - Apr 2013

    Fingerprint

    Equipment and Supplies
    Hospital Mortality
    Heart-Assist Devices
    Myocardial Infarction
    Registries
    Heart Failure
    Atrial Pressure
    Myocarditis
    Patient Rights
    Tertiary Healthcare
    Heart Transplantation
    Tertiary Care Centers
    Pulmonary Artery
    Arterial Pressure
    Hemodynamics
    Prospective Studies
    Hemorrhage
    Blood Pressure
    Mortality

    Keywords

    • Invasive hemodynamics
    • Mechanical circulatory support
    • Right heart failure

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

    Cite this

    Kapur, N. K., Paruchuri, V., Jagannathan, A., Steinberg, D., Chakrabarti, A. K., Pinto, D., ... DeNofrio, D. (2013). Mechanical circulatory support for right ventricular failure. JACC: Heart Failure, 1(2), 127-134. https://doi.org/10.1016/j.jchf.2013.01.007

    Mechanical circulatory support for right ventricular failure. / Kapur, Navin K.; Paruchuri, Vikram; Jagannathan, Anand; Steinberg, Daniel; Chakrabarti, Anjan K.; Pinto, Duane; Aghili, Nima; Najjar, Samer; Finley, John; Orr, Nicole M.; Tempelhof, Michael; Mudd, James; Kiernan, Michael S.; Pham, Duc Thinh; DeNofrio, David.

    In: JACC: Heart Failure, Vol. 1, No. 2, 04.2013, p. 127-134.

    Research output: Contribution to journalArticle

    Kapur, NK, Paruchuri, V, Jagannathan, A, Steinberg, D, Chakrabarti, AK, Pinto, D, Aghili, N, Najjar, S, Finley, J, Orr, NM, Tempelhof, M, Mudd, J, Kiernan, MS, Pham, DT & DeNofrio, D 2013, 'Mechanical circulatory support for right ventricular failure', JACC: Heart Failure, vol. 1, no. 2, pp. 127-134. https://doi.org/10.1016/j.jchf.2013.01.007
    Kapur NK, Paruchuri V, Jagannathan A, Steinberg D, Chakrabarti AK, Pinto D et al. Mechanical circulatory support for right ventricular failure. JACC: Heart Failure. 2013 Apr;1(2):127-134. https://doi.org/10.1016/j.jchf.2013.01.007
    Kapur, Navin K. ; Paruchuri, Vikram ; Jagannathan, Anand ; Steinberg, Daniel ; Chakrabarti, Anjan K. ; Pinto, Duane ; Aghili, Nima ; Najjar, Samer ; Finley, John ; Orr, Nicole M. ; Tempelhof, Michael ; Mudd, James ; Kiernan, Michael S. ; Pham, Duc Thinh ; DeNofrio, David. / Mechanical circulatory support for right ventricular failure. In: JACC: Heart Failure. 2013 ; Vol. 1, No. 2. pp. 127-134.
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    abstract = "Objectives: The aim of this study was to explore the clinical utility of a commercially available centrifugal flow pump as a centrifugal flow-right ventricular support device (CF-RVSD) in patients with right ventricular failure (RVF). Background: RVF is associated with high in-hospital mortality. Limited data regarding efficacy of the CF-RVSD for RVF exist. Methods: We retrospectively reviewed data from 46 patients receiving a CF-RVSD for RVF from a registry comprising data from 8 tertiary-care hospitals in the United States. CF-RVSD use was recorded in the setting of acute myocardial infarction; myocarditis; chronic left heart failure; after valve surgery, orthotopic heart transplantation, left ventricular assist device surgery, coronary bypass grafting. Devices were implanted via the percutaneous (n = 22) or surgical (n = 24) route. Results: No intraprocedural mortality was observed. Mean time from admission to CF-RVSD implantation was 5.7 ± 8.5 days, with a mean of 6,769 ± 789 rotations/min, providing 4.2 ± 1.3 l/min of flow. Mean duration of support was 5.4 ± 5.1 days. Mean arterial pressure (65 ± 12 mm Hg vs. 73 ± 14 mm Hg; p <0.05), right atrial pressure (21 ± 8 mm Hg vs. 16 ± 7 mm Hg; p = 0.05), pulmonary artery systolic pressure (43 ± 15 mm Hg vs. 33 ± 15 mm Hg; p = 0.01), and cardiac index (1.7 ± 0.7 vs. 2.2 ± 0.6; p = 0.01) were improved within 48 h of CF-RVSD implantation. Total in-hospital mortality was 57{\%} and was lowest in the setting of left ventricular assist device implantation, chronic left heart failure, and acute myocardial infarction. Increased age, biventricular failure, and Thrombolysis In Myocardial Infarction-defined major bleeding were associated with increased in-hospital mortality. Conclusions: Use of the CF-RVSD for RVF is clinically feasible and associated with improved hemodynamic status. Observations from the registry of patients who have received this device may support the development of prospective studies that will examine the role of percutaneous circulatory support for RVF.",
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    AU - Kapur, Navin K.

    AU - Paruchuri, Vikram

    AU - Jagannathan, Anand

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    AU - Chakrabarti, Anjan K.

    AU - Pinto, Duane

    AU - Aghili, Nima

    AU - Najjar, Samer

    AU - Finley, John

    AU - Orr, Nicole M.

    AU - Tempelhof, Michael

    AU - Mudd, James

    AU - Kiernan, Michael S.

    AU - Pham, Duc Thinh

    AU - DeNofrio, David

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    N2 - Objectives: The aim of this study was to explore the clinical utility of a commercially available centrifugal flow pump as a centrifugal flow-right ventricular support device (CF-RVSD) in patients with right ventricular failure (RVF). Background: RVF is associated with high in-hospital mortality. Limited data regarding efficacy of the CF-RVSD for RVF exist. Methods: We retrospectively reviewed data from 46 patients receiving a CF-RVSD for RVF from a registry comprising data from 8 tertiary-care hospitals in the United States. CF-RVSD use was recorded in the setting of acute myocardial infarction; myocarditis; chronic left heart failure; after valve surgery, orthotopic heart transplantation, left ventricular assist device surgery, coronary bypass grafting. Devices were implanted via the percutaneous (n = 22) or surgical (n = 24) route. Results: No intraprocedural mortality was observed. Mean time from admission to CF-RVSD implantation was 5.7 ± 8.5 days, with a mean of 6,769 ± 789 rotations/min, providing 4.2 ± 1.3 l/min of flow. Mean duration of support was 5.4 ± 5.1 days. Mean arterial pressure (65 ± 12 mm Hg vs. 73 ± 14 mm Hg; p <0.05), right atrial pressure (21 ± 8 mm Hg vs. 16 ± 7 mm Hg; p = 0.05), pulmonary artery systolic pressure (43 ± 15 mm Hg vs. 33 ± 15 mm Hg; p = 0.01), and cardiac index (1.7 ± 0.7 vs. 2.2 ± 0.6; p = 0.01) were improved within 48 h of CF-RVSD implantation. Total in-hospital mortality was 57% and was lowest in the setting of left ventricular assist device implantation, chronic left heart failure, and acute myocardial infarction. Increased age, biventricular failure, and Thrombolysis In Myocardial Infarction-defined major bleeding were associated with increased in-hospital mortality. Conclusions: Use of the CF-RVSD for RVF is clinically feasible and associated with improved hemodynamic status. Observations from the registry of patients who have received this device may support the development of prospective studies that will examine the role of percutaneous circulatory support for RVF.

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