title: [Right ventricular dysfunction after left ventricular assist device implantation].
abstract: OBJECTIVE
  The frequency of long-term left ventricular assist device (LVAD) implantation is increasing. Acute right ventricular dysfunction or right ventricular failure after LVAD implantation has important influence on morbidity and mortality. The aim of our study was to assess the management of right ventricular dysfunction after LVAD implantation.
  
  
  METHODS
  The study group comprised 21 patients with implanted HeartMate II LVAD since December, 2006 to April, 2009. We evaluated in retrospective fashion baseline parameters of cardiovascular and other organ systems before LVAD implantation, applied pharmacological and mechanical support for the right ventricle, and important clinical outcomes to the end ofJune, 2009.
  
  
  RESULTS
  LVAD was implanted in 18 men and 3 women with mean age of 48.7 +/- 11.2 years. The most frequent diagnosis was dilatational cardiomyopathy (9 patients; 42.9%), and the most frequent indication for implantation was bridge-to-transplantation (19 patients; 90.4%). Pharmacological support of the right ventricle after LVAD implantation comprised dobutamine (21 patients; 100%), milrinone (21 patients; 100%), isoproterenol (1 patient; 4.8%), and levosimendan (5 patients; 23.8%). In 2 (9.5%) cases there was a need for repeated application of levosimendan during postoperative course. Inhalational nitric oxide was used in 14 (66.7%) patients. Despite extensive pharmacological support, 3 (14.3%) patients needed right ventricular assist device (RVAD) implantation. Most patients (9; 42.8%) survived to heart transplantation; in one (4.8%) case LVAD was successfuly explanted; 6 (28.6%) patients is living with LVAD; 5 (23.8%) patients died during LVAD support.
  
  
  CONCLUSIONS
  After LVAD implantation there is a need for aggressive pharmacological, and in some cases mechanical, support of the right ventricular function to provide adequate blood flow to LVAD in order to minimize morbidity and mortality.
authors.affiliation: Klinika anesteziologie a resuscitace, Kardiocentrum IKEM Praha. hynek.riha@ikem.cz
authors.forename: H
authors.initials: H
authors.lastname: Ríha
authors.forename: I
authors.initials: I
authors.lastname: Netuka
authors.forename: T
authors.initials: T
authors.lastname: Kotulák
authors.forename: J
authors.initials: J
authors.lastname: Malý
authors.forename: M
authors.initials: M
authors.lastname: Pind'ák
authors.forename: P
authors.initials: P
authors.lastname: Kellovský
authors.forename: F
authors.initials: F
authors.lastname: Kopác
authors.forename: D
authors.initials: D
authors.lastname: Hodr
authors.forename: O
authors.initials: O
authors.lastname: Szarszoi
authors.forename: J
authors.initials: J
authors.lastname: Kettner
authors.forename: H
authors.initials: H
authors.lastname: Al-Hiti
authors.forename: Z
authors.initials: Z
authors.lastname: Dorazilová
authors.forename: T
authors.initials: T
authors.lastname: Marek
authors.forename: I
authors.initials: I
authors.lastname: Skalský
authors.forename: J
authors.initials: J
authors.lastname: Pirk
mesh_terms: D002316:Cardiotonic Agents / Q000627:therapeutic use; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D018497:Ventricular Dysfunction, Right / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology
chemical_list: D002316:Cardiotonic Agents