title: Recovery of right heart function with temporary right ventricular assist using a centrifugal pump in patients with severe biventricular failure.
abstract: BACKGROUND
  Long-term outcomes of a biventricular assist device (BiVAD) support are worse than those of an isolated left ventricular assist device (LVAD) support. This study evaluated our strategy for right heart failure using a temporary right VAD (RVAD) with an extracorporeal centrifugal pump.
  
  
  METHODS
  From January 2001 to December 2010, 108 patients underwent LVAD implantation at our institution and their clinical outcomes were studied.
  
  
  RESULTS
  A temporary centrifugal RVAD was implanted in 26 patients. Multivariate logistic regression revealed pre-operative extracorporeal life support (odds ratio [OR], 37.0), central venous pressure (OR, 1.2), mean pulmonary artery pressure (OR, 0.9), and serum total bilirubin (OR, 1.4) were the risk factors for RVAD requirement. RVAD-off test was conducted, and 11 of the 26 patients showed significant recovery of right heart function and were eventually removed from RVAD support. The survival of patients with isolated LVAD was significantly better than those with a paracorporeal pulsatile BiVAD (80% vs 11% at 1 year, p < 0.001). However, there was no significant difference between the survival of patients who underwent isolated LVAD support and those who were initially implanted with temporary BiVAD but underwent the RVAD removal (80% vs 73% at 1 year, p = 0.827).
  
  
  CONCLUSIONS
  Our strategy with temporary RVAD for severe acute right heart failure was effective in selecting the patients who could be weaned from RVAD support. Patient survival was improved by avoiding the long-term support with a paracorporeal pulsatile BiVAD.
authors.affiliation: Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Saito
authors.forename: Taichi
authors.initials: T
authors.lastname: Sakaguchi
authors.forename: Shigeru
authors.initials: S
authors.lastname: Miyagawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nishi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yoshikawa
authors.forename: Satsuki
authors.initials: S
authors.lastname: Fukushima
authors.forename: Takashi
authors.initials: T
authors.lastname: Daimon
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D002648:Child; D005112:Extracorporeal Circulation / Q000295:instrumentation*; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult
chemical_list: D001663:Bilirubin