title: Right ventricular dysfunction in children supported with pulsatile ventricular assist devices.
abstract: OBJECTIVE
  To describe the incidence and severity of right ventricular dysfunction (RVD) in pediatric ventricular assist device (VAD) recipients and to identify the preoperative characteristics associated with RVD and their effect on outcomes.
  
  
  METHODS
  Children bridged to transplantation from 2004 to 2011 were included. RVD was defined as the use of a left VAD (LVAD) with an elevated central venous pressure of >16 mm Hg with inotropic therapy and/or inhaled nitric oxide for >96 hours or biventricular assist (BiVAD).
  
  
  RESULTS
  A total of 57 children (median age, 2.97 years; range 35 days to 15.8 years) were supported. Of the 57, 43 (75%) had an LVAD, and of those, 10 developed RVD. The remaining 14 (25%) required BiVAD. Thus, RVD occurred in 24 of 57 patients (42%). Preoperative variables such as younger age (P = .01), use of extracorporeal mechanical support (P = .006), and elevated urea (P = .03), creatinine (P = .02), and bilirubin (P = .001) were associated with RVD. Multiple logistic regression analysis indicated that elevated urea and extracorporeal mechanical support (odds ratio, 26.4; 95% confidence interval, 2.3-307.3; and odds ratio, 27.8; 95% confidence interval, 2.5-312.3, respectively) were risk factors for BiVAD. The patients who developed RVD on LVAD had a complicated postoperative course but excellent survival (100%), comparable to those with preserved right ventricular function (91%). The survival for those requiring BiVAD was reduced (71%).
  
  
  CONCLUSIONS
  RVD occurred in approximately 40% of pediatric VAD recipients and affects their peri-implantation morbidity and bridging outcomes. Preoperative extracorporeal membrane oxygenation and elevated urea were risk factors for BiVAD. Additional studies of the management of RVD in children after VAD implantation are warranted.
authors.affiliation: Cardiothoracic Unit, Great Ormond Street Hospital for Children, London, United Kingdom. Electronic address: Ann.Karimova@gosh.nhs.uk.
authors.forename: Ann
authors.initials: A
authors.lastname: Karimova
authors.affiliation: Department of Pediatric Cardiology, Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors.forename: Charissa R
authors.initials: CR
authors.lastname: Pockett
authors.affiliation: Cardiothoracic Unit, Great Ormond Street Hospital for Children, London, United Kingdom.
authors.forename: Nagore
authors.initials: N
authors.lastname: Lasuen
authors.affiliation: Cardiothoracic Unit, Great Ormond Street Hospital for Children, London, United Kingdom.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Dedieu
authors.affiliation: Department of Pediatric Cardiology, Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rutledge
authors.affiliation: Cardiothoracic Unit, Great Ormond Street Hospital for Children, London, United Kingdom.
authors.forename: Mathew
authors.initials: M
authors.lastname: Fenton
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Mass.
authors.forename: Christina
authors.initials: C
authors.lastname: Vanderpluym
authors.affiliation: Department of Pediatric Cardiology, Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors.forename: Ivan M
authors.initials: IM
authors.lastname: Rebeyka
authors.affiliation: Cardiothoracic Unit, Great Ormond Street Hospital for Children, London, United Kingdom.
authors.forename: Troy E
authors.initials: TE
authors.lastname: Dominguez
authors.affiliation: Department of Pediatric Cardiology, Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors.forename: Holger
authors.initials: H
authors.lastname: Buchholz
mesh_terms: D000293:Adolescent; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011474:Prosthesis Design; D011673:Pulsatile Flow; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D014850:Waiting Lists