Clinical characteristics and outcomes of patients requiring prolonged inotropes after left ventricular assist device implantation.
Adult
Arrhythmias, Cardiac
/ epidemiology
Cardiotonic Agents
/ therapeutic use
Female
Heart Failure
/ etiology
Heart-Assist Devices
/ adverse effects
Humans
Incidence
Male
Middle Aged
Prognosis
Retrospective Studies
Risk Factors
Survival Rate
Time Factors
Treatment Outcome
Ventricular Dysfunction, Right
/ complications
inotropes
left ventricular assist device
right ventricular failure
Journal
Artificial organs
ISSN: 1525-1594
Titre abrégé: Artif Organs
Pays: United States
ID NLM: 7802778
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
11
11
2019
revised:
22
03
2020
accepted:
25
03
2020
pubmed:
4
4
2020
medline:
12
10
2021
entrez:
4
4
2020
Statut:
ppublish
Résumé
Limited data exist regarding patients with continuous-flow left ventricular assist device (LVAD) support who require long-term inotropes. Our primary objective was to evaluate the clinical characteristics and all-cause mortality of LVAD recipients with prolonged inotrope use (PIU). Secondary endpoints were to compare predictors of PIU, mortality, risk of late re-initiation of inotropes, time to gastrointestinal bleed (GIB), infection, and arrhythmias. Retrospective cohort study was conducted on adult patients with primary continuous-flow LVADs implanted from January 2008 to February 2017 and the patients were followed up through February 2018. We defined PIU as ≥14 days of inotrope support. Kaplan-Meier method, competing risk models and Cox proportional hazard models were used. Final analytic sample was 203 patients, 58% required PIU, and 10% were discharged on inotropes. There was no difference in preimplant characteristics. One-year survival rate was 87% if no PIU required, 74% if PIU required, and 72% if discharged on inotropes. PIU was associated with longer length of stay and higher incidence of GIB. We found no association between PIU and late re-initiation of inotropes, infection or arrhythmias. Adjusted hazard risk of death was increased in patients with PIU (HR = 1.66, P = .046), older age (HR = 1.28, P = .031), and higher creatinine levels (HR = 1.60, P = .007). Prolonged inotrope use is frequently encountered following LVAD implantation and is associated with adverse prognosis but remains a therapeutic option. Inability to wean inotropes prior to hospital discharge is a marker of patients at particularly higher risk of mortality following LVAD implantation.
Substances chimiques
Cardiotonic Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
E382-E393Subventions
Organisme : Texas Tech University
Informations de copyright
© 2020 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.
Références
Benjamin EJ, Virani SS, Callaway CW, Chamberlain Alanna M, Chang Alexander R, Cheng Susan, et al. Heart disease and stroke statistics-2018 update: a report from the American Heart Association. Circulation. 2018;137:e67-492. https://doi.org/10.1161/CIR.0000000000000558.
Feldman D, Pamboukian SV, Teuteberg JJ, Birks E, Lietz K, Moore SA, et al. The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant. 2013;32:157-87. https://doi.org/10.1016/j.healun.2012.09.013.
Jorde UP, Kushwaha SS, Tatooles AJ, Naka Y, Bhat G, Long JW, et al. Results of the destination therapy post-food and drug administration approval study with a continuous flow left ventricular assist device: a prospective study using the INTERMACS registry (Interagency Registry for Mechanically Assisted Circulatory Support). J Am Coll Cardiol. 2014;63:1751-7. https://doi.org/10.1016/j.jacc.2014.01.053.
Kormos RL, Teuteberg JJ, Pagani FD, Russell SD, John R, Miller LW, et al. 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. 2010;139:1316-24. https://doi.org/10.1016/j.jtcvs.2009.11.020.
Baumwol J, Macdonald PS, Keogh AM, Kotlyar E, Spratt P, Jansz P, et al. Right heart failure and "failure to thrive" after left ventricular assist device: clinical predictors and outcomes. J Heart Lung Transplant. 2011;30:888-95. https://doi.org/10.1016/j.healun.2011.03.006.
Meineri M, Van Rensburg AE, Vegas A. Right ventricular failure after LVAD implantation: prevention and treatment. Best Pract Res Clin Anaesthesiol. 2012;26:217-29. https://doi.org/10.1016/j.bpa.2012.03.006.
Mehra MR, Naka Y, Uriel N, Goldstein DJ, Cleveland JC, Colombo PC, et al. MOMENTUM 3 Investigators. A fully magnetically levitated circulatory pump for advanced heart failure. N Engl J Med. 2017;376:440-50. https://doi.org/10.1056/NEJMoa1610426.
Slaughter MS, Rogers JG, Milano CA, Russell SD, Conte JV, Feldman D, et al. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med. 2009;361:2241-51. https://doi.org/10.1056/NEJMoa0909938.
INTERMACS Adverse Event Definitions: Adult and Pediatric patients. Manual of Operations Version 5.0, Appendix A: Adverse Event Definitions. [cited 2019 Jun 30]. Available from: http://www.uab.edu/medicine/intermacs/images/protocol_5.0/appendix_a/AE-Definitions-Final-02-4-2016.docx
Aissaoui N, Morshuis M, Schoenbrodt M, Hakim Meibodi K, Kizner L, Börgermann J, et al. Temporary right ventricular mechanical circulatory support for the management of right ventricular failure in critically ill patients. J Thorac Cardiovasc Surg. 2013;146:186-91. https://doi.org/10.1016/j.jtcvs.2013.01.044.
Fitzpatrick JR 3rd, Frederick JR, Hiesinger W, Hsu VM, McCormick RC, Kozin ED, et al. Early planned institution of biventricular mechanical circulatory support results in improved outcomes compared with delayed conversion of a left ventricular assist device to a biventricular assist device. J Thorac Cardiovasc Surg. 2009;137:971-7. https://doi.org/10.1016/j.jtcvs.2008.09.021.
Anyanwu EC, Kagan V, Bhatia A, Tehrani DM, Adatya S, Kim G, et al. Home inotropes in patients supported with left ventricular assist devices. ASAIOJ. 2019;65:e7-11. https://doi.org/10.1097/MAT.0000000000000753.
Drakos SG, Janicki L, Horne BD, Kfoury AG, Reid BB, Clayson S, et al. Risk factors predictive of right ventricular failure after left ventricular assist device implantation. Am J Cardiol. 2010;105:1030-5. https://doi.org/10.1016/j.amjcard.2009.11.026.
Critsinelis A, Kurihara C, Volkovicher N, Kawabori M, Sugiura T, Manon M, et al. MELD-XI scoring system to predict outcomes in patients who undergo LVAD implantation. Ann Thorac Surg. 2018;106:513-9. https://doi.org/10.1016/j.athoracsur.2018.02.082.
Schenk S, McCarthy PM, Blackstone EH, Feng J, Starling RC, Navia JL, et al. Duration of inotropic support after left ventricular assist device implantation: risk factors and impact on outcome. J Thorac Cardiovasc Surg. 2006;131:447-54.
Kirklin JK, Pagani FD, Kormos RL, Stevenson LW, Blume ED, Myers SL, et al. Eighth annual INTERMACS report: special focus on framing the impact of adverse events. J Heart Lung Transplant. 2017;36:1080-6. https://doi.org/10.1016/j.healun.2017.07.005.
Kiernan MS, Grandin EW, Brinkley M Jr, Kapur NK, Pham DT, Ruthazer R, et al. 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. Circ Heart Fail. 2017;10:e003863. https://doi.org/10.1161/CIRCHEARTFAILURE.117.003863.
Patil NP, Mohite PN, Sabashnikov A, Dhar D, Weymann A, Zeriouh M, et al. Preoperative predictors and outcomes of right ventricular assist device implantation after continuous-flow left ventricular assist device implantation. J Thorac Cardiovasc Surg. 2015;150:1651-8. https://doi.org/10.1016/j.jtcvs.2015.07.090.
Yang JA, Kato TS, Shulman BP, Takayama H, Farr M, Jorde UP, et al. 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. https://doi.org/10.1016/j.healun.2012.02.027.
Raina A, Seetha Rammohan HR, Gertz ZM, Rame JE, Woo YJ, Kirkpatrick JN. Postoperative right ventricular failure after left ventricular assist device placement is predicted by preoperative echocardiographic structural, hemodynamic, and functional parameters. J Card Fail. 2013;19:16-24. https://doi.org/10.1016/j.cardfail.2012.11.001.
Joly JM, El-Dabh A, Kirklin JK, Marshell R, Smith MG, Acharya D, et al. High right atrial pressure and low pulse pressure predict gastrointestinal bleeding in patients with left ventricular assist device. J Card Fail. 2018;24:487-93. https://doi.org/10.1016/j.cardfail.2018.03.003.
Sparrow CT, Nassif ME, Raymer DS, Novak E, LaRue SJ, Schilling JD. Pre-operative right ventricular dysfunction is associated with gastrointestinal bleeding in patients supported with continuous-flow left ventricular assist devices. JACC Heart Fail. 2015;3:956-64. https://doi.org/10.1016/j.jchf.2015.09.009.
Acharya D, Sanam K, Revilla-Martinez M, Hashim T, Morgan CJ, Pamboukian SV, et al. Infections, arrhythmias, and hospitalizations on home intravenous inotropic therapy. Am J Cardiol. 2016;117:952-6. https://doi.org/10.1016/j.amjcard.2015.12.030.
Joly JM, El-Dabh A, Marshell R, Chatterjee A, Smith MG, Tresler M, et al. Performance of noninvasive assessment in the diagnosis of right heart failure after left ventricular assist device. ASAIO J. 2019;65:449-55. https://doi.org/10.1097/MAT.0000000000000830.
Goldraich L, Kawajiri H, Foroutan F, Braga J, Billia P, Misurka J, et al. Tricuspid valve annular dilation as a predictor of right ventricular failure after implantation of a left ventricular assist device. J Card Surg. 2016;31:110-6. https://doi.org/10.1111/jocs.12685.
Brinkley DM, Ho KK, Drazner MH, Kociol RD. The prognostic value of the relationship between right atrial and pulmonary capillary wedge pressure in diverse cardiovascular conditions. Am Heart J. 2018;199:31-6. https://doi.org/10.1016/j.ahj.2018.01.006.
Bhat G, Ali A, Yost G, Tatooles A. Right atrial to pulmonary capillary wedge pressure ratio as predictor for postoperative outcomes in left ventricular assist device implantation. J Heart Lung Transplant. 2017;36:S341. https://doi.org/10.1016/j.healun.2017.01.954.
Tallaj JA, Kirklin JK, Brown RN, Rayburn BK, Bourge RC, Benza RL, et al. Post-heart transplant diastolic dysfunction is a risk factor for mortality. J Am Coll Cardiol. 2007;50:1064-9. https://doi.org/10.1016/j.jacc.2007.06.007.
Kang G, Ha R, Banerjee D. Pulmonary artery pulsatility index predicts right ventricular failure after left ventricular assist device implantation. J Heart Lung Transplant. 2017;5:67-73. https://doi.org/10.1016/j.healun.2015.06.009.
Kochav SM, Flores RJ, Truby LK, Topkara VK. Prognostic impact of pulmonary artery pulsatility index (PAPi) in patients with advanced heart failure: insights from the ESCAPE trial. J Card Fail. 2018;24:453-9. https://doi.org/10.1016/j.cardfail.2018.03.008.
Hazelbag CM, Klungel OH, van Staa TP, de Boer A, Groenwold RH. Left truncation results in substantial bias of the relation between time-dependent exposures and adverse events. Ann Epidemiol. 2015;25:590-6. https://doi.org/10.1016/j.annepidem.2015.03.019.