JTCS Click here to go to SJM website.
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Patrick M. McCarthy
Eugene H. Blackstone
Randall C. Starling
Jose L. Navia
Nicholas G. Smedira
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Schenk, S.
Right arrow Articles by Fukamachi, K.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Schenk, S.
Right arrow Articles by Fukamachi, K.
Related Collections
Right arrow Transplantation - heart

J Thorac Cardiovasc Surg 2006;131:447-454
© 2006 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Duration of inotropic support after left ventricular assist device implantation: Risk factors and impact on outcome

Soren Schenk, MD a , Patrick M. McCarthy, MD a , b , c , d , Eugene H. Blackstone, MD b , d , e , * , Jingyuan Feng, MS d , e , Randall C. Starling, MD, MPH c , d , f , Jose L. Navia, MD b , Lingmei Zhou, MS d , Katherine J. Hoercher, RN b , c , d , Nicholas G. Smedira, MD b , c , d , Kiyotaka Fukamachi, MD, PhD a

a Department of Biomedical Engineering, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
b Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio
c George M. and Linda H. Kaufman Center for Heart Failure, The Cleveland Clinic Foundation, Cleveland, Ohio
d Transplant Center, The Cleveland Clinic Foundation, Cleveland, Ohio
e Department of Quantitative Health Sciences, The Cleveland Clinic Foundation, Cleveland, Ohio
f Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio

Received for publication April 8, 2005; revisions received August 31, 2005; accepted for publication September 19, 2005.

* Address for reprints: Eugene H. Blackstone, MD, Department of Thoracic and Cardiovascular Surgery/JJ40, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195 (Email: blackse{at}ccf.org).

OBJECTIVES: Because duration of inotropic support after left ventricular assist device implantation has been recognized as a surrogate for right ventricular dysfunction, we sought to (1) identify its preimplantation risk factors, particularly its association with preimplantation right ventricular dysfunction, and (2) assess its impact on clinical outcomes.

METHODS: Between 1991 and 2002, left ventricular assist devices were implanted in 207 patients, exclusive of those receiving preoperative mechanical circulatory support, which precluded measuring right ventricular stroke work. Duration of inotropic support was analyzed as a continuous variable, truncated by death or transplantation, and in turn as a risk factor for these 2 events.

RESULTS: Inotropic support decreased from 100% on the day of implantation to 57%, 33%, and 22% by days 7, 14, and 21. Its duration was strongly associated with lower preimplantation right ventricular stroke work index, older age, and nonischemic cardiomyopathy and was associated (P < .04) with higher mortality before transplantation but not with transition to transplantation. We identified no preimplantation risk factors for right ventricular assist device use because of its relatively infrequent use in this population (18 patients, only 4 of whom survived to transplantation).

CONCLUSION: Duration of inotropic support after left ventricular assist device insertion is strongly correlated with low preimplantation right ventricular stroke work index. In turn, it was associated with reduced survival to transplantation. Thus, right ventricular stroke work measured before implantation might be useful in decision making for biventricular support, destination therapy, or total artificial heart.

Abbreviations and Acronyms LVAD = left ventricular assist device; RV = right ventricular; RVAD = right ventricular assist device; RVD = right ventricular dysfunction; RVSWI = right ventricular stroke work index




This article has been cited by other articles:


Home page
 J Am Coll CardiolHome page
J. C. Matthews, T. M. Koelling, F. D. Pagani, and K. D. Aaronson
The right ventricular failure risk score a pre-operative tool for assessing the risk of right ventricular failure in left ventricular assist device candidates.
J. Am. Coll. Cardiol., June 3, 2008; 51(22): 2163 - 2172.
[Abstract] [Full Text] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
M. E. Stone
Current Status of Mechanical Circulatory Assistance
Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2007; 11(3): 185 - 204.
[Abstract] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2006 by The American Association for Thoracic Surgery.