title: Effects of a percutaneous mechanical circulatory support device for medically refractory right ventricular failure.
abstract: BACKGROUND
  Medically refractory right ventricular failure (MR-RVF) is associated with high in-hospital mortality and is managed with surgical assist devices, atrial septostomy, or extracorporeal membrane oxygenation. This study explored the hemodynamic effect associated with a percutaneous RV support device (pRVSD) for MR-RVF.
  
  
  METHODS
  Between 2008 and 2010, 9 patients with MR-RVF, defined as cardiogenic shock despite maximal medical therapy, were treated with a pRVSD. Medical records were reviewed for demographics, hemodynamic and laboratory data, and details of pRVSD implantation.
  
  
  RESULTS
  MR-RVF was due to severe sepsis in 1 patient (11.1%), post-cardiotomy syndrome in 2 (22.2%), and acute inferior wall myocardial infarction (IWMI) in 6 (66.7%). Five patients underwent right internal jugular-to-femoral cannulation, and 4 required bifemoral cannulation. No intra-procedural deaths or major vascular complications requiring surgical or peripheral intervention occurred. Time from admission to pRVSD implantation was 2.9 ± 3.3 days, with an average of 6516 ± 698 rotations/min, providing flow at 3.3 ± 0.4 liters/min. Mean duration of pRVSD activation was 3.1 ± 1.8 days. Compared with pre-procedural values, mean arterial pressure (57 ± 7 vs 75 ± 19 mm Hg, p < 0.05), right atrial pressure (22 ± 3 vs 15 ± 6 mm Hg, p < 0.05), cardiac index (1.5 ± 0.4 vs 2.3 ± 0.5 liters/min/m(2), p < 0.05), mixed venous oxygen saturation (40 ± 14 vs 58 ± 4 percent, p < 0.05), and RV stroke work (3.4 ± 3.9 vs 9.7 ± 6.8 g · m/beat, p < 0.05) improved significantly within 24 hours of pRVSD implantation. In-hospital mortality was 44% (n = 4). Time from admission to pRVSD placement was lower in patients who survived to hospital discharge (0.9 ± 0.8 days) vs non-survivors (4.8 ± 3.5 days; p = 0.04). All survivors presented with IWMI.
  
  
  CONCLUSIONS
  Use of a pRVSD for MR-RVF is feasible and associated with improved hemodynamics. Algorithms promoting earlier pRVSD use in MR-RVF warrant further investigation.
authors.affiliation: The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts 02111, USA. Nkapur@tuftsmedicalcenter.org
authors.forename: Navin K
authors.initials: NK
authors.lastname: Kapur
authors.forename: Vikram
authors.initials: V
authors.lastname: Paruchuri
authors.forename: Ravikiran
authors.initials: R
authors.lastname: Korabathina
authors.forename: Ramzi
authors.initials: R
authors.lastname: Al-Mohammdi
authors.forename: James O
authors.initials: JO
authors.lastname: Mudd
authors.forename: Jordan
authors.initials: J
authors.lastname: Prutkin
authors.forename: Michele
authors.initials: M
authors.lastname: Esposito
authors.forename: Ameer
authors.initials: A
authors.lastname: Shah
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kiernan
authors.forename: Candice
authors.initials: C
authors.lastname: Sech
authors.forename: Duc Thinh
authors.initials: DT
authors.lastname: Pham
authors.forename: Marvin A
authors.initials: MA
authors.lastname: Konstam
authors.forename: David
authors.initials: D
authors.lastname: Denofrio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*