Model for end-stage liver disease predicts right ventricular failure in patients with left ventricular assist devices

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• 作者：Gardner L. Yost ; Laura Coyle ; Geetha Bhat…
• 关键词：Ventricle ; right ; Statistics ; risk analysis ; Circulatory assist devices ; LVAD ; RVAD ; Liver ; Outcomes
• 刊名：Journal of Artificial Organs
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：19
• 期：1
• 页码：21-28
• 全文大小：653 KB
• 参考文献：1.Kirklin JK, Naftel DC, Pagani FD, Kormos RL, Stevenson LW, Blume ED, Miller MA, Baldwin JT, Young JB. Sixth INTERMACS annual report: a 10,000-patient database. J Heart Lung Transplant. 2014;33:555–64.CrossRef PubMed
  2.Aaronson KD, Patel H, Pagani FD. Patient selection for left ventricular assist device therapy. Ann Thorac Surg. 2003;75:S29–35.CrossRef PubMed
  3.Slaughter MS, Pagani FD, Rogers JG, Miller LW, Sun B, Russell SD, Starling RC, Chen L, Boyle AJ, Chillcott S, Adamson RM, Blood MS, Camacho MT, Idrissi KA, Petty M, Sobieski M, Wright S, Myers TJ, Farrar DJ; HeartMate II Clinical Investigators. Clinical management of continuous-flow left ventricular assist devices in advanced heart failure. J Heart Lung Transplant. 2010;29(4 Suppl):S1–39.PubMed
  4.Patel ND, Weiss ES, Schaffer J, et al. Right heart dysfunction after left ventricular assist device implantation: a comparison of the pulsatile HeartMate I and axial-flow HeartMate II devices. Ann Thorac Surg. 2008;86:832–40.CrossRef PubMed
  5.Lazar JF, Swartz MF, Schiralli MP, Schneider M, Pisula B, Hallinan W, Hicks GL, Massey HT. Survival after left ventricular assist device with and without temporary right ventricular support. Ann Thorac Surg. 2013;96:2155–60.CrossRef PubMed
  6.Patlolla B, Beygui R, Haddad F. Right-ventricular failure following left ventricle assist device implantation. Curr Opin Cardiol. 2013;28:223–33.CrossRef PubMed
  7.Baumwol J, Macdonald PS, Keogh AM, Kotlyar E, Spratt P, Jansz P, Hayward CS. Right heart failure and “failure to thrive” after left ventricular assist device: clinical predictors and outcomes. J Heart Lung Transplant. 2011;30:888–95.PubMed
  8.Kormos RL, Teuteberg JJ, Pagani FD, Russel SD, John R, Miller LW, Massey T, Milano CA, Moazami N, Sundareswaran KS, Farrar DJ. Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: incidence, risk factors, and effect on outcomes. J Thorac Cardiovasc Surg. 2012;139:1316–24.CrossRef
  9.Dang NC, Topkara VK, Michelle M, et al. Right heart failure after left ventricular assist device implantation in patients with chronic congestive heart failure. J Heart Lung Transplant. 2006;25:1–6.CrossRef PubMed
  10.Rich JD. Right ventricular failure in patients with left ventricular assist devices. Cardiol Clin. 2012;30:291–302.CrossRef PubMed
  11.Ochiai Y, McCarthy PM, Smedira NG, et al. Predictors of severe right ventricular failure after implantable left ventricular assist device insertion: analysis of 245 patients. Circulation. 2002;106:I198–202.CrossRef PubMed
  12.Matthews JC, Koelling TM, Pagani FD, Aaronson KD. The right ventricular failure risk score a preoperative tool for assessing the risk of right ventricular failure in left ventricular assist device candidates. J Am Coll Cardiol. 2008;51:2163–72.CrossRef PubMed PubMedCentral
  13.Grant AD, Smedira NG, Starling RC, Marwick TH. Independent and incremental role of quantitative right ventricular evaluation for the prediction of right ventricular failure after left ventricular assist device implantation. J Am Coll Cardiol. 2012;60:521–8.CrossRef PubMed
  14.Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33:464–70.CrossRef PubMed
  15.Kim MS, Kato TS, Farr M, Wu C, Given RC, Collado E, Mancini DM, Schulze PC. Hepatic dysfunction in ambulatory patients with heart failure. J Am Coll Cardiol. 2013;61:2253–61.CrossRef PubMed PubMedCentral
  16.Deo SV, Daly RC, Altarabsheh SE, Hasin T, Zhoa Y, Shah IK, Stulak JM, Boilson BA, Schirger JA, Joyce LD, Park SJ. Predictive value of the model for end-stage liver disease score in patients undergoing left ventricular assist device implantation. ASAIO J. 2013;59:57–62.CrossRef PubMed
  17.Kato TS, Stevens GR, Jiang J, Schulze PC, Gukasyan N, Lippel M, Levin A, Homma S, Mancini DM, Farr M. Risk stratification of ambulatory patients with advanced heart failure undergoing evaluation for heart transplantation. J Heart Lung Transplant. 2013;32:333–40.CrossRef PubMed PubMedCentral
  18.Yang JA, Kato TS, Shulman BP, Takayama H, Farr M, Jorde UP, Mancini DM, Naka Y, Schulze PC. Liver dysfunction as a predictor of outcomes in patients with advanced heart failure requiring ventricular assist device support: use of the model of end-stage liver disease (MELD) and MELD eXcluding INR (MELD-XI) scoring system. J Heart Lung Transplant. 2012;31:601–10.CrossRef PubMed PubMedCentral
  19.Giallourakis CC, Rosenberg PM, Friedman LS. The liver in heart failure. Clin Liver Dis. 2002;6:947–67 (viii–ix).CrossRef PubMed
  20.Myers RP, Cerini R, Sayegh R, et al. Cardiac hepatopathy: clinical, hemodynamic, and histologic characteristics and correlations. Hepatology. 2003;37:393–400.CrossRef PubMed
  21.Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank K, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000;31:864–71.CrossRef PubMed
  22.Morgan JA, John R, Lee BJ, et al. Is severe right ventricular failure in left ventricular assist device recipients a risk factor for unsuccessful bridging to transplant and post-transplant mortality. Ann Thorac Surg. 2004;77:859–63.CrossRef PubMed
  
• 作者单位：Gardner L. Yost (1)
  Laura Coyle (1)
  Geetha Bhat (1)
  Antone J. Tatooles (2)
  
  1. Center for Heart Transplant and Assist Devices, Outpatient Pavilion, H&V Administration, Advocate Christ Medical Center, 6th Floor, 4440 West 95th Street, Oak Lawn, IL, 60453, USA
  2. Division of Cardiothoracic Surgery, Advocate Christ Medical Center, Oak Lawn, IL, USA
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Surgery
  Cardiac Surgery
  Biomedical Engineering
  Orthopedics
  Nephrology
  Hepatology
  
• 出版者：Springer Japan
• ISSN：1619-0904

文摘

High rates of right ventricular failure continue to affect postoperative outcomes in patients implanted with left ventricular assist devices (LVADs). Development of right ventricular failure and implantation with right ventricular assist devices is known to be associated with significantly increased mortality. The model for end-stage liver disease (MELD) score is an effective means of evaluating liver dysfunction. We investigated the prognostic utility of postoperative MELD on post-LVAD implantation outcomes. MELD scores, demographic data, and outcomes including length of stay, survival, and postoperative right ventricular failure were collected for 256 patients implanted with continuous flow LVADs. Regression and Kaplan–Meier analyses were used to investigate the relationship between MELD and all outcomes. Increased MELD score was found to be an independent predictor of both right heart failure and necessity for RVAD implantation (OR 1.097, CI 1.040–1.158, p = 0.001; OR 1.121, CI 1.015, p = 0.024, respectively). Patients with RV failure and who underwent RVAD implantation had reduced postoperative survival compared to patients with RV dysfunction (no RV failure = 651.4 ± 609.8 days, RV failure = 392.6 ± 444.8 days, RVAD = 89.3 ± 72.8 days; p < 0.001). In conclusion, MELD can be used to reliably predict postoperative right heart failure and the necessity for RVAD implantation. Those patients with RV failure and RVADs experience significantly increased postoperative mortality compared to those without RV dysfunction.