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

Research output: Contribution to journalArticle

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
Externally publishedYes

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 O.; 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, JO, 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 O. ; 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.
@article{a1fb16bab88d48f29ccaa779fa18823d,
title = "Mechanical circulatory support for right ventricular failure",
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.",
keywords = "Invasive hemodynamics, Mechanical circulatory support, Right heart failure",
author = "Kapur, {Navin K.} and Vikram Paruchuri and Anand Jagannathan and Daniel Steinberg and Chakrabarti, {Anjan K.} and Duane Pinto and Nima Aghili and Samer Najjar and John Finley and Orr, {Nicole M.} and Michael Tempelhof and Mudd, {James O.} and Kiernan, {Michael S.} and Pham, {Duc Thinh} and David DeNofrio",
year = "2013",
month = "4",
doi = "10.1016/j.jchf.2013.01.007",
language = "English (US)",
volume = "1",
pages = "127--134",
journal = "JACC: Heart Failure",
issn = "2213-1779",
publisher = "Elsevier BV",
number = "2",

}

TY - JOUR

T1 - Mechanical circulatory support for right ventricular failure

AU - Kapur, Navin K.

AU - Paruchuri, Vikram

AU - Jagannathan, Anand

AU - Steinberg, Daniel

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 O.

AU - Kiernan, Michael S.

AU - Pham, Duc Thinh

AU - DeNofrio, David

PY - 2013/4

Y1 - 2013/4

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.

AB - 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.

KW - Invasive hemodynamics

KW - Mechanical circulatory support

KW - Right heart failure

UR - http://www.scopus.com/inward/record.url?scp=84877986376&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84877986376&partnerID=8YFLogxK

U2 - 10.1016/j.jchf.2013.01.007

DO - 10.1016/j.jchf.2013.01.007

M3 - Article

C2 - 24621838

AN - SCOPUS:84877986376

VL - 1

SP - 127

EP - 134

JO - JACC: Heart Failure

JF - JACC: Heart Failure

SN - 2213-1779

IS - 2

ER -