Use of percutaneous mechanical circulatory support for right ventricular failure
Recommended Citation
Gupta K, Lemor A, Alkhatib A, McBride P, Cowger J, Grafton G, Alaswad K, O'Neill W, Villablanca P, and Basir MB. Use of percutaneous mechanical circulatory support for right ventricular failure. Catheter Cardiovasc Interv 2024; 103(6):909-916.
Document Type
Article
Publication Date
5-1-2024
Publication Title
Catheterization and cardiovascular interventions
Abstract
BACKGROUND: Utilization of right ventricular mechanical circulatory support (RV-MCS) devices has been limited by a lack of recognition of RV failure as well as a lack of availability and experience with RV-MCS.
AIMS: We report a single-center experience with the use of percutaneous RV-MCS and report predictors of adverse outcomes.
METHODS: This was a single-center retrospective cohort study. Data from consecutive patients who received RV-MCS for any indication between June 2015 and January 2022 were included. Data on baseline comorbidities, hemodynamics, and laboratory values were collected. The primary outcome was in-hospital mortality analyzed as a logistic outcome in a multivariable model. These variables were further ranked by their predictive value.
RESULTS: Among 58 consecutive patients enrolled, the median age was 66 years, 31% were female and 53% were white. The majority of the patients (48%) were hospitalized for acute on chronic heart failure. The majority of the patients were SCAI SHOCK Stage D (67%) and 34 (64%) patients had MCS placed within 24 h of the onset of shock. Before placement of RV-MCS, median central venous pressure (CVP) and RV stroke work index were 20 mmHg and 8.9 g m/m(2), respectively. Median serum lactate was 3.5 (1.6, 6.2) mmol/L. Impella RP was implanted in 50% and ProtekDuo in the remaining 50%. Left ventricular MCS was concomitantly used in 66% of patients. Twenty-eight patients (48.3%) died. In these patients, median serum lactate was significantly higher (4.1 [2.3, 13.0] vs. 2.2 [1.4, 4.0] mmol/L, p = 0.007) and a trend toward higher median CVP (24 [18, 31] vs. 19 [14, 24] mmHg, p = 0.052). In the multivariable logistic model, both serum lactate and CVP before RV-MCS placement were independent predictors of in-hospital mortality. Serum lactate had the highest predictive value.
CONCLUSION: In our real-world cohort, 52% of patients treated with RV-MCS survived their index hospitalization. Serum lactate at presentation and CVP were the strongest predictors of in-hospital mortality.
Medical Subject Headings
Humans; Female; Male; Retrospective Studies; Heart-Assist Devices; Aged; Ventricular Function, Right; Heart Failure; Hospital Mortality; Treatment Outcome; Middle Aged; Risk Factors; Time Factors; Ventricular Dysfunction, Right; Risk Assessment; Recovery of Function; Prosthesis Implantation; Biomarkers
PubMed ID
38584525
Volume
103
Issue
6
First Page
909
Last Page
916
