TY - JOUR
T1 - Preoperative Risk Factors for Mortality After Biventricular Assist Device Implantation
AU - Zahr, Firas
AU - Ootaki, Yoshio
AU - Starling, Randall C.
AU - Smedira, Nicholas G.
AU - Yamani, Mohamad
AU - Thuita, Lucy
AU - Fukamachi, Kiyotaka
PY - 2008/12
Y1 - 2008/12
N2 - Background: A right ventricular assist device is a treatment option for patients with severe right ventricular failure after left ventricular assist device (LVAD) implantation. Recognition of risk factors for mortality after biventricular assist device (BiVAD) implantation is important for patient selection and optimal outcomes. Methods: We reviewed our experiences between 1991 and 2005 in 44 patients who were supported by both an LVAD and a right ventricular assist device. Results: Thirteen patients (30%) survived until heart transplantation, and 31 patients (70%) died while on support. The multivariate analysis shows that post-LVAD extracorporeal membrane oxygenation and worsening renal function are associated with the highest postoperative mortality. The univariate analysis also included previous thoracic surgery and ischemic cardiomyopathy as potential preoperative indicators for poor outcome after BiVAD implants. No differences were observed in the rates for the need of preoperative support with a ventilator, an intra-aortic balloon pump, or extracorporeal membrane oxygenation, or in the rates of postoperative complications between survivors and nonsurvivors. Conclusions: BiVAD implantation remains one of the challenges in treating severe heart failure. Previous cardiac surgery, elevated creatinine, and post-LVAD extracorporeal membrane oxygenation were risk factors for mortality after BiVAD implantation. Dialated Cardiomyopathy on the other hand was associated with a more favorable outcome.
AB - Background: A right ventricular assist device is a treatment option for patients with severe right ventricular failure after left ventricular assist device (LVAD) implantation. Recognition of risk factors for mortality after biventricular assist device (BiVAD) implantation is important for patient selection and optimal outcomes. Methods: We reviewed our experiences between 1991 and 2005 in 44 patients who were supported by both an LVAD and a right ventricular assist device. Results: Thirteen patients (30%) survived until heart transplantation, and 31 patients (70%) died while on support. The multivariate analysis shows that post-LVAD extracorporeal membrane oxygenation and worsening renal function are associated with the highest postoperative mortality. The univariate analysis also included previous thoracic surgery and ischemic cardiomyopathy as potential preoperative indicators for poor outcome after BiVAD implants. No differences were observed in the rates for the need of preoperative support with a ventilator, an intra-aortic balloon pump, or extracorporeal membrane oxygenation, or in the rates of postoperative complications between survivors and nonsurvivors. Conclusions: BiVAD implantation remains one of the challenges in treating severe heart failure. Previous cardiac surgery, elevated creatinine, and post-LVAD extracorporeal membrane oxygenation were risk factors for mortality after BiVAD implantation. Dialated Cardiomyopathy on the other hand was associated with a more favorable outcome.
KW - Heart failure
KW - right ventricular failure
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U2 - 10.1016/j.cardfail.2008.08.009
DO - 10.1016/j.cardfail.2008.08.009
M3 - Article
C2 - 19041048
AN - SCOPUS:56549100184
SN - 1071-9164
VL - 14
SP - 844
EP - 849
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 10
ER -