title: Duration of inotropic support after left ventricular assist device implantation: risk factors and impact on outcome.
abstract: OBJECTIVE
  Because duration of inotropic support after left ventricular assist device implantation has been recognized as a surrogate for right ventricular dysfunction, we sought to (1) identify its preimplantation risk factors, particularly its association with preimplantation right ventricular dysfunction, and (2) assess its impact on clinical outcomes.
  
  
  METHODS
  Between 1991 and 2002, left ventricular assist devices were implanted in 207 patients, exclusive of those receiving preoperative mechanical circulatory support, which precluded measuring right ventricular stroke work. Duration of inotropic support was analyzed as a continuous variable, truncated by death or transplantation, and in turn as a risk factor for these 2 events.
  
  
  RESULTS
  Inotropic support decreased from 100% on the day of implantation to 57%, 33%, and 22% by days 7, 14, and 21. Its duration was strongly associated with lower preimplantation right ventricular stroke work index, older age, and nonischemic cardiomyopathy and was associated (P < .04) with higher mortality before transplantation but not with transition to transplantation. We identified no preimplantation risk factors for right ventricular assist device use because of its relatively infrequent use in this population (18 patients, only 4 of whom survived to transplantation).
  
  
  CONCLUSIONS
  Duration of inotropic support after left ventricular assist device insertion is strongly correlated with low preimplantation right ventricular stroke work index. In turn, it was associated with reduced survival to transplantation. Thus, right ventricular stroke work measured before implantation might be useful in decision making for biventricular support, destination therapy, or total artificial heart.
authors.affiliation: Department of Biomedical Engineering, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Soren
authors.initials: S
authors.lastname: Schenk
authors.forename: Patrick M
authors.initials: PM
authors.lastname: McCarthy
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.forename: Jingyuan
authors.initials: J
authors.lastname: Feng
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
authors.forename: Jose L
authors.initials: JL
authors.lastname: Navia
authors.forename: Lingmei
authors.initials: L
authors.lastname: Zhou
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Hoercher
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Smedira
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Fukamachi
mesh_terms: D009202:Cardiomyopathies / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D005260:Female; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology / Q000628:therapy; D016278:Ventricular Function, Right
chemical_list: D002316:Cardiotonic Agents