Duration of inotropic support after left ventricular assist device implantation: risk factors and impact on outcome.
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.
Schenk
Soren
S
Department of Biomedical Engineering, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
McCarthy
Patrick M
PM
Blackstone
Eugene H
EH
Feng
Jingyuan
J
Starling
Randall C
RC
Navia
Jose L
JL
Zhou
Lingmei
L
Hoercher
Katherine J
KJ
Smedira
Nicholas G
NG
Fukamachi
Kiyotaka
K
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
D002316:Cardiotonic Agents