USE OF PERCUTANEOUS MECHANICAL CIRCULATORY SUPPORT FOR RIGHT VENTRICULAR FAILURE
Recommended Citation
McBride P, Gupta K, Lemor A, Alkhatib A, Cowger JA, Grafton G, Alaswad K, O'Neill WW, Villablanca PA, Basir MB. USE OF PERCUTANEOUS MECHANICAL CIRCULATORY SUPPORT FOR RIGHT VENTRICULAR FAILURE. J Am Coll Cardiol 2024; 83(13):456.
Document Type
Conference Proceeding
Publication Date
4-1-2024
Publication Title
J Am Coll Cardiol
Abstract
Background RV dysfunction is a significant cause of in-hospital morbidity/mortality due to under recognition and lack of experience with right ventricular mechanical circulatory support (RV-MCS). The purpose of this project was to identify if intervention, in addition to timing, impacted outcomes. Methods Single center retrospective cohort study of patients treated with RV-MCS for any indication between 2015-2022. Baseline comorbidities, hemodynamic, and laboratory data were collected. Primary outcome was in-hospital mortality analyzed as a logistic outcome in a multivariable model. Results Among 58 patients, median age was 66 years. 31% of patients were female. 50% of patients were hospitalized for acute on chronic heart failure. 64% were SCAI SHOCK Stage D. Median time from index hospitalization to placement of RV-MCS was 2 days. 50% were treated with Impella RP and 50% received Protek Duo. Left ventricular mechanical circulatory support (LV-MCS) was used concomitantly with 45% of people. RV-MCS resulted in lower MAP (79.5 vs 67.6, p<0.001), and CVP (20 vs 15 mmHg, p<.002). Additionally, increased CO (3.8 vs 5.8, p <.001), CI (1.9 vs 2.7, p<.001), and RV SWI (8.9 vs 12.7 g*m/m2, p<.006) were observed at 24 hours. Lactate levels were significantly lower at 24 hours (3.5 vs 1.8, p<.05). In-hospital mortality of individuals treated with RV-MCS was 48.3%. In these individuals, median CVP and CVP/PCWP trended towards being increased (24 vs 19, p =.052 and 1.2 vs 1.0, p=.086, respectively). Median serum lactate was also significantly higher (4.1 vs 2.2, p<.007). In the multivariable logistic model, age (OR 1.11 [1.01, 1.22], p<.033), diabetes mellitus (OR 7.7 [1.0, 59.0], p<.048), CVP (OR 1.18 [1.03, 1.35], p<.017) and serum lactate (OR 1.32 [1.06, 1.65], p<.013) prior to placement of RV-MCS were associated with mortality. Conclusion Patients treated with RV-MCS had an in-hospital mortality of 48%. Use of RV-MCS was associated with reduced MAP, and improved CVP, systolic PA pressure, CO, CI, RVSWI, and lactate clearance. Diabetes mellitus, elevated CVP, and elevated lactate at presentation were independently associated with increased mortality.
Volume
83
Issue
13
First Page
456
