Early Right Ventricular Assist Device Use in Patients Undergoing Continuous-Flow Left Ventricular Assist Device Implantation: Incidence and Risk Factors from the Interagency Registry for Mechanically Assisted Circulatory Support

Michael S. Kiernan*, E. Wilson Grandin, Marshall Brinkley, Navin K. Kapur, Duc Thinh Pham, Robin Ruthazer, J. Eduardo Rame, Pavan Atluri, Edo Y. Birati, Guilherme H. Oliveira, Francis D. Pagani, James K. Kirklin, David Naftel, Robert L. Kormos, Jeffrey J. Teuteberg, David Denofrio

*Corresponding author for this work

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: To investigate preimplant risk factors associated with early right ventricular assist device (RVAD) use in patients undergoing continuous-flow left ventricular assist device (LVAD) surgery. Methods and Results: Patients in the Interagency Registry for Mechanically Assisted Circulatory Support who underwent primary continuous-flow-LVAD surgery were examined for concurrent or subsequent RVAD implantation within 14 days of LVAD. Risk factors for RVAD implantation and the combined end point of RVAD or death within 14 days of LVAD were assessed with stepwise logistic regression. We compared survival between patients with and without RVAD using Kaplan-Meier method and Cox proportional hazards modeling. Of 9976 patients undergoing continuous-flow-LVAD implantation, 386 patients (3.9%) required an RVAD within 14 days of LVAD surgery. Preimplant characteristics associated with RVAD use included interagency registry for mechanically assisted circulatory support patient profiles 1 and 2, the need for preoperative extracorporeal membrane oxygenation or renal replacement therapy, severe preimplant tricuspid regurgitation, history of cardiac surgery, and concomitant procedures other than tricuspid valve repair at the time of LVAD. Hemodynamic determinants included elevated right atrial pressure, reduced pulmonary artery pulse pressure, and reduced stroke volume. The final model demonstrated good performance for both RVAD implant (area under the curve, 0.78) and the combined end point of RVAD or death within 14 days (area under the curve, 0.73). Compared with patients receiving an isolated LVAD, patients requiring RVAD had decreased 1-and 6-month survival: 78.1% versus 95.8% and 63.6% versus 87.9%, respectively (P<0.0001 for both). Conclusions: The need for RVAD implantation after LVAD is associated with indices of global illness severity, markers of end-organ dysfunction, and profiles of hemodynamic instability.

Original languageEnglish (US)
Article numbere003863
JournalCirculation: Heart Failure
Volume10
Issue number10
DOIs
StatePublished - Oct 1 2017

Fingerprint

Heart-Assist Devices
Registries
Incidence
Area Under Curve
Severity of Illness Index
Hemodynamics
Tricuspid Valve Insufficiency
Extracorporeal Membrane Oxygenation

Keywords

  • atrial pressure
  • blood pressure
  • heart
  • humans
  • risk factors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Kiernan, Michael S. ; Wilson Grandin, E. ; Brinkley, Marshall ; Kapur, Navin K. ; Pham, Duc Thinh ; Ruthazer, Robin ; Eduardo Rame, J. ; Atluri, Pavan ; Birati, Edo Y. ; Oliveira, Guilherme H. ; Pagani, Francis D. ; Kirklin, James K. ; Naftel, David ; Kormos, Robert L. ; Teuteberg, Jeffrey J. ; Denofrio, David. / Early Right Ventricular Assist Device Use in Patients Undergoing Continuous-Flow Left Ventricular Assist Device Implantation : Incidence and Risk Factors from the Interagency Registry for Mechanically Assisted Circulatory Support. In: Circulation: Heart Failure. 2017 ; Vol. 10, No. 10.
@article{8673e8fee3b44653b1301b953f54c3fb,
title = "Early Right Ventricular Assist Device Use in Patients Undergoing Continuous-Flow Left Ventricular Assist Device Implantation: Incidence and Risk Factors from the Interagency Registry for Mechanically Assisted Circulatory Support",
abstract = "Background: To investigate preimplant risk factors associated with early right ventricular assist device (RVAD) use in patients undergoing continuous-flow left ventricular assist device (LVAD) surgery. Methods and Results: Patients in the Interagency Registry for Mechanically Assisted Circulatory Support who underwent primary continuous-flow-LVAD surgery were examined for concurrent or subsequent RVAD implantation within 14 days of LVAD. Risk factors for RVAD implantation and the combined end point of RVAD or death within 14 days of LVAD were assessed with stepwise logistic regression. We compared survival between patients with and without RVAD using Kaplan-Meier method and Cox proportional hazards modeling. Of 9976 patients undergoing continuous-flow-LVAD implantation, 386 patients (3.9{\%}) required an RVAD within 14 days of LVAD surgery. Preimplant characteristics associated with RVAD use included interagency registry for mechanically assisted circulatory support patient profiles 1 and 2, the need for preoperative extracorporeal membrane oxygenation or renal replacement therapy, severe preimplant tricuspid regurgitation, history of cardiac surgery, and concomitant procedures other than tricuspid valve repair at the time of LVAD. Hemodynamic determinants included elevated right atrial pressure, reduced pulmonary artery pulse pressure, and reduced stroke volume. The final model demonstrated good performance for both RVAD implant (area under the curve, 0.78) and the combined end point of RVAD or death within 14 days (area under the curve, 0.73). Compared with patients receiving an isolated LVAD, patients requiring RVAD had decreased 1-and 6-month survival: 78.1{\%} versus 95.8{\%} and 63.6{\%} versus 87.9{\%}, respectively (P<0.0001 for both). Conclusions: The need for RVAD implantation after LVAD is associated with indices of global illness severity, markers of end-organ dysfunction, and profiles of hemodynamic instability.",
keywords = "atrial pressure, blood pressure, heart, humans, risk factors",
author = "Kiernan, {Michael S.} and {Wilson Grandin}, E. and Marshall Brinkley and Kapur, {Navin K.} and Pham, {Duc Thinh} and Robin Ruthazer and {Eduardo Rame}, J. and Pavan Atluri and Birati, {Edo Y.} and Oliveira, {Guilherme H.} and Pagani, {Francis D.} and Kirklin, {James K.} and David Naftel and Kormos, {Robert L.} and Teuteberg, {Jeffrey J.} and David Denofrio",
year = "2017",
month = "10",
day = "1",
doi = "10.1161/CIRCHEARTFAILURE.117.003863",
language = "English (US)",
volume = "10",
journal = "Circulation: Heart Failure",
issn = "1941-3297",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

Kiernan, MS, Wilson Grandin, E, Brinkley, M, Kapur, NK, Pham, DT, Ruthazer, R, Eduardo Rame, J, Atluri, P, Birati, EY, Oliveira, GH, Pagani, FD, Kirklin, JK, Naftel, D, Kormos, RL, Teuteberg, JJ & Denofrio, D 2017, 'Early Right Ventricular Assist Device Use in Patients Undergoing Continuous-Flow Left Ventricular Assist Device Implantation: Incidence and Risk Factors from the Interagency Registry for Mechanically Assisted Circulatory Support', Circulation: Heart Failure, vol. 10, no. 10, e003863. https://doi.org/10.1161/CIRCHEARTFAILURE.117.003863

Early Right Ventricular Assist Device Use in Patients Undergoing Continuous-Flow Left Ventricular Assist Device Implantation : Incidence and Risk Factors from the Interagency Registry for Mechanically Assisted Circulatory Support. / Kiernan, Michael S.; Wilson Grandin, E.; Brinkley, Marshall; Kapur, Navin K.; Pham, Duc Thinh; Ruthazer, Robin; Eduardo Rame, J.; Atluri, Pavan; Birati, Edo Y.; Oliveira, Guilherme H.; Pagani, Francis D.; Kirklin, James K.; Naftel, David; Kormos, Robert L.; Teuteberg, Jeffrey J.; Denofrio, David.

In: Circulation: Heart Failure, Vol. 10, No. 10, e003863, 01.10.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Early Right Ventricular Assist Device Use in Patients Undergoing Continuous-Flow Left Ventricular Assist Device Implantation

T2 - Incidence and Risk Factors from the Interagency Registry for Mechanically Assisted Circulatory Support

AU - Kiernan, Michael S.

AU - Wilson Grandin, E.

AU - Brinkley, Marshall

AU - Kapur, Navin K.

AU - Pham, Duc Thinh

AU - Ruthazer, Robin

AU - Eduardo Rame, J.

AU - Atluri, Pavan

AU - Birati, Edo Y.

AU - Oliveira, Guilherme H.

AU - Pagani, Francis D.

AU - Kirklin, James K.

AU - Naftel, David

AU - Kormos, Robert L.

AU - Teuteberg, Jeffrey J.

AU - Denofrio, David

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Background: To investigate preimplant risk factors associated with early right ventricular assist device (RVAD) use in patients undergoing continuous-flow left ventricular assist device (LVAD) surgery. Methods and Results: Patients in the Interagency Registry for Mechanically Assisted Circulatory Support who underwent primary continuous-flow-LVAD surgery were examined for concurrent or subsequent RVAD implantation within 14 days of LVAD. Risk factors for RVAD implantation and the combined end point of RVAD or death within 14 days of LVAD were assessed with stepwise logistic regression. We compared survival between patients with and without RVAD using Kaplan-Meier method and Cox proportional hazards modeling. Of 9976 patients undergoing continuous-flow-LVAD implantation, 386 patients (3.9%) required an RVAD within 14 days of LVAD surgery. Preimplant characteristics associated with RVAD use included interagency registry for mechanically assisted circulatory support patient profiles 1 and 2, the need for preoperative extracorporeal membrane oxygenation or renal replacement therapy, severe preimplant tricuspid regurgitation, history of cardiac surgery, and concomitant procedures other than tricuspid valve repair at the time of LVAD. Hemodynamic determinants included elevated right atrial pressure, reduced pulmonary artery pulse pressure, and reduced stroke volume. The final model demonstrated good performance for both RVAD implant (area under the curve, 0.78) and the combined end point of RVAD or death within 14 days (area under the curve, 0.73). Compared with patients receiving an isolated LVAD, patients requiring RVAD had decreased 1-and 6-month survival: 78.1% versus 95.8% and 63.6% versus 87.9%, respectively (P<0.0001 for both). Conclusions: The need for RVAD implantation after LVAD is associated with indices of global illness severity, markers of end-organ dysfunction, and profiles of hemodynamic instability.

AB - Background: To investigate preimplant risk factors associated with early right ventricular assist device (RVAD) use in patients undergoing continuous-flow left ventricular assist device (LVAD) surgery. Methods and Results: Patients in the Interagency Registry for Mechanically Assisted Circulatory Support who underwent primary continuous-flow-LVAD surgery were examined for concurrent or subsequent RVAD implantation within 14 days of LVAD. Risk factors for RVAD implantation and the combined end point of RVAD or death within 14 days of LVAD were assessed with stepwise logistic regression. We compared survival between patients with and without RVAD using Kaplan-Meier method and Cox proportional hazards modeling. Of 9976 patients undergoing continuous-flow-LVAD implantation, 386 patients (3.9%) required an RVAD within 14 days of LVAD surgery. Preimplant characteristics associated with RVAD use included interagency registry for mechanically assisted circulatory support patient profiles 1 and 2, the need for preoperative extracorporeal membrane oxygenation or renal replacement therapy, severe preimplant tricuspid regurgitation, history of cardiac surgery, and concomitant procedures other than tricuspid valve repair at the time of LVAD. Hemodynamic determinants included elevated right atrial pressure, reduced pulmonary artery pulse pressure, and reduced stroke volume. The final model demonstrated good performance for both RVAD implant (area under the curve, 0.78) and the combined end point of RVAD or death within 14 days (area under the curve, 0.73). Compared with patients receiving an isolated LVAD, patients requiring RVAD had decreased 1-and 6-month survival: 78.1% versus 95.8% and 63.6% versus 87.9%, respectively (P<0.0001 for both). Conclusions: The need for RVAD implantation after LVAD is associated with indices of global illness severity, markers of end-organ dysfunction, and profiles of hemodynamic instability.

KW - atrial pressure

KW - blood pressure

KW - heart

KW - humans

KW - risk factors

UR - http://www.scopus.com/inward/record.url?scp=85031666007&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85031666007&partnerID=8YFLogxK

U2 - 10.1161/CIRCHEARTFAILURE.117.003863

DO - 10.1161/CIRCHEARTFAILURE.117.003863

M3 - Article

C2 - 29021348

AN - SCOPUS:85031666007

VL - 10

JO - Circulation: Heart Failure

JF - Circulation: Heart Failure

SN - 1941-3297

IS - 10

M1 - e003863

ER -