Late-onset right ventricular failure in patients with preoperative small left ventricle after implantation of continuous flow left ventricular assist device

Teruhiko Imamura, Koichiro Kinugawa, Naoko Kato, Hironori Muraoka, Takeo Fujino, Toshiro Inaba, Hisataka Maki, Osamu Kinoshita, Masaru Hatano, Shunei Kyo, Minoru Ono

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: The continuous flow (CF) left ventricular assist device (LVAD) has replaced the pulsatile flow (PF) LVAD because of its advantages of better patient survival and higher quality of life. However, "late-onset right ventricular failure (RVF)" after CF LVAD implantation has emerged as an increasing concern, but little is known about the mechanism. Methods and Results: We retrospectively analyzed the 3-month hemodynamic and echocardiographic data from 38 consecutive patients who had received CF LVADs, and from 22 patients who had received PF LVADs. Late-onset RVF was defined as persistent right ventricular stroke work index (RVSWI) <4.0 g/m2 at any rotation speed and after saline infusion test at 5 weeks after implantation of CF LVAD. Patients with late-onset RVF had significantly impaired exercise tolerance indicated by shorter 6-min walking distance and lower peak V ̇O2, and worsened tricuspid regurgitation, together with enlargement of the RV under CF LVAD treatment (all P<0.05). Univariable analyses demonstrated that preoperative smaller LV diastolic diameter (LVDd) was the risk factor for late-onset RVF with a cutoff value of 64 mm calculated by ROC analysis (area under curve, 0.925). In contrast, there was no correlation between preoperative LVDd and postoperative RVSWI in the PF LVAD group, though their preoperative background was worse than that of the CF group. Conclusions: In the setting of preoperative small LVDd, CF LVAD may cause late-onset RVF by leftward shift of the interventricular septum.

Original languageEnglish
Pages (from-to)625-633
Number of pages9
JournalCirculation Journal
Volume78
Issue number3
DOIs
Publication statusPublished - 2014

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Heart-Assist Devices
Heart Ventricles
Pulsatile Flow
Stroke
Tricuspid Valve Insufficiency
Exercise Tolerance
ROC Curve
Walking
Area Under Curve
Hemodynamics
Quality of Life
Survival

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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Late-onset right ventricular failure in patients with preoperative small left ventricle after implantation of continuous flow left ventricular assist device. / Imamura, Teruhiko; Kinugawa, Koichiro; Kato, Naoko; Muraoka, Hironori; Fujino, Takeo; Inaba, Toshiro; Maki, Hisataka; Kinoshita, Osamu; Hatano, Masaru; Kyo, Shunei; Ono, Minoru.

In: Circulation Journal, Vol. 78, No. 3, 2014, p. 625-633.

Research output: Contribution to journalArticle

Imamura, T, Kinugawa, K, Kato, N, Muraoka, H, Fujino, T, Inaba, T, Maki, H, Kinoshita, O, Hatano, M, Kyo, S & Ono, M 2014, 'Late-onset right ventricular failure in patients with preoperative small left ventricle after implantation of continuous flow left ventricular assist device', Circulation Journal, vol. 78, no. 3, pp. 625-633. https://doi.org/10.1253/circj.CJ-13-1201
Imamura, Teruhiko ; Kinugawa, Koichiro ; Kato, Naoko ; Muraoka, Hironori ; Fujino, Takeo ; Inaba, Toshiro ; Maki, Hisataka ; Kinoshita, Osamu ; Hatano, Masaru ; Kyo, Shunei ; Ono, Minoru. / Late-onset right ventricular failure in patients with preoperative small left ventricle after implantation of continuous flow left ventricular assist device. In: Circulation Journal. 2014 ; Vol. 78, No. 3. pp. 625-633.
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T1 - Late-onset right ventricular failure in patients with preoperative small left ventricle after implantation of continuous flow left ventricular assist device

AU - Imamura, Teruhiko

AU - Kinugawa, Koichiro

AU - Kato, Naoko

AU - Muraoka, Hironori

AU - Fujino, Takeo

AU - Inaba, Toshiro

AU - Maki, Hisataka

AU - Kinoshita, Osamu

AU - Hatano, Masaru

AU - Kyo, Shunei

AU - Ono, Minoru

PY - 2014

Y1 - 2014

N2 - Background: The continuous flow (CF) left ventricular assist device (LVAD) has replaced the pulsatile flow (PF) LVAD because of its advantages of better patient survival and higher quality of life. However, "late-onset right ventricular failure (RVF)" after CF LVAD implantation has emerged as an increasing concern, but little is known about the mechanism. Methods and Results: We retrospectively analyzed the 3-month hemodynamic and echocardiographic data from 38 consecutive patients who had received CF LVADs, and from 22 patients who had received PF LVADs. Late-onset RVF was defined as persistent right ventricular stroke work index (RVSWI) <4.0 g/m2 at any rotation speed and after saline infusion test at 5 weeks after implantation of CF LVAD. Patients with late-onset RVF had significantly impaired exercise tolerance indicated by shorter 6-min walking distance and lower peak V ̇O2, and worsened tricuspid regurgitation, together with enlargement of the RV under CF LVAD treatment (all P<0.05). Univariable analyses demonstrated that preoperative smaller LV diastolic diameter (LVDd) was the risk factor for late-onset RVF with a cutoff value of 64 mm calculated by ROC analysis (area under curve, 0.925). In contrast, there was no correlation between preoperative LVDd and postoperative RVSWI in the PF LVAD group, though their preoperative background was worse than that of the CF group. Conclusions: In the setting of preoperative small LVDd, CF LVAD may cause late-onset RVF by leftward shift of the interventricular septum.

AB - Background: The continuous flow (CF) left ventricular assist device (LVAD) has replaced the pulsatile flow (PF) LVAD because of its advantages of better patient survival and higher quality of life. However, "late-onset right ventricular failure (RVF)" after CF LVAD implantation has emerged as an increasing concern, but little is known about the mechanism. Methods and Results: We retrospectively analyzed the 3-month hemodynamic and echocardiographic data from 38 consecutive patients who had received CF LVADs, and from 22 patients who had received PF LVADs. Late-onset RVF was defined as persistent right ventricular stroke work index (RVSWI) <4.0 g/m2 at any rotation speed and after saline infusion test at 5 weeks after implantation of CF LVAD. Patients with late-onset RVF had significantly impaired exercise tolerance indicated by shorter 6-min walking distance and lower peak V ̇O2, and worsened tricuspid regurgitation, together with enlargement of the RV under CF LVAD treatment (all P<0.05). Univariable analyses demonstrated that preoperative smaller LV diastolic diameter (LVDd) was the risk factor for late-onset RVF with a cutoff value of 64 mm calculated by ROC analysis (area under curve, 0.925). In contrast, there was no correlation between preoperative LVDd and postoperative RVSWI in the PF LVAD group, though their preoperative background was worse than that of the CF group. Conclusions: In the setting of preoperative small LVDd, CF LVAD may cause late-onset RVF by leftward shift of the interventricular septum.

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