073 Right Ventricle Contractile Reserve as a Pre-operative Tool for Assessing RV failure after Continuous Flow LVAD Implantation

详细信息    查看全文

• 作者：Guillaume Deswarte¹ ; Mathias Kirsch² ; Jean Christian Roussel³ ; Pierre Franç ; ois Lesault¹ ; Emmanuelle Vermes² ; Daniel Duveau³ ; Pascal Gué ; ret¹ ; Jean Luc Dubois Randé ; ¹ ; Daniel Loisance² ; Luc Hittinger¹ ; Jean Noë ; l Trochu⁴ ; Thibaud Damy¹
• 刊名：Archives of Cardiovascular Diseases Supplements
• 出版年：2010
• 出版时间：January 2010
• 年：2010
• 卷：2
• 期：1
• 页码：25
• 全文大小：91 K

文摘

Introduction

Latest generation continuous flow left ventricular assist devices (LVADs) have been proposed as an alternative to heart transplantation for end-stage heart failure. However, postoperative right ventricle (RV) dysfunction remains common and has a negative impact on prognosis. Purpose of our study was to identify echocardiographic or hemodynamic parameters that could predict early RV failure after LVAD implantation in patients with biventricular dysfunction.

Methods

Fourteen patients with biventricular dysfunction who have been evaluated for LVAD implantation were included. Right and left ventricular dysfunction were respectively defined as: tricuspid annular plane excursion < 16 mm (TAPSE) and LV ejection fraction < 35 % . In all patients, preoperative measurements were obtained at rest. In 7 patients, right heart catheterization was performed simultaneously with increasing doses of dobutamine (15¦Ã/Kg/min). Primary endpoint was death caused by right ventricle systolic dysfunction or need for right ventricle mechanical support within 30 days after surgery (RVSD+).

Results

Mean recipient age was 58¡À7 years. Primary end-point (RVSD+) was noted in five patients. Preoperative demographic, echocardiographic and hemodynamic data were similar between RVSD+ and RVSD- patients (Table). Percent increase of TAPSE and systolic PAP between basal and high dobutamine dose was significantly lower in RVSD+ than in RVSD- patients.

Conclusion

	Baseline Measurement (n=14)	Change after Dobutamine infusion, % (n=7)
	RVSD-	RVSD+	p	RVSD-	RVSD+	p
N	9	5
TAPSE, mm	14 ¡À 2	14 ¡À 2	0.9	55 ¡À 5	26 ¡À 2	0.03
Systolic PAP, mmHg	51 ¡À 7	53 ¡À 6	0.8	42 ¡À 8	4 ¡À 7	0.05
Cardiac Output, l/min	3.3 ¡À 0.5	3.5 ¡À 0.5	0.9	87 ¡À 10	93 ¡À 47	0.7
Pulm Vasc Res, Wood	3.9 ¡À 1	4.3 ¡À 1	0.6	2 ¡À 41	-36 ¡À 7	0.8