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 O. Mudd, Michael S. Kiernan, Duc Thinh Pham, David DeNofrio

*Corresponding author for this work

Research output: Contribution to journalArticle

56 Scopus citations

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 1 2013

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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., Aghili, N., Najjar, S., Finley, J., Orr, N. M., Tempelhof, M., Mudd, J. O., Kiernan, M. S., Pham, D. T., & 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