title: Mechanical circulatory support for right ventricular failure.
abstract: OBJECTIVE
  The aim of this study was to explore the clinical utility of a commercially available centrifugal flow pump as a centrifugal flow-right ventricular support device (CF-RVSD) in patients with right ventricular failure (RVF).
  
  
  BACKGROUND
  RVF is associated with high in-hospital mortality. Limited data regarding efficacy of the CF-RVSD for RVF exist.
  
  
  METHODS
  We retrospectively reviewed data from 46 patients receiving a CF-RVSD for RVF from a registry comprising data from 8 tertiary-care hospitals in the United States. CF-RVSD use was recorded in the setting of acute myocardial infarction; myocarditis; chronic left heart failure; after valve surgery, orthotopic heart transplantation, left ventricular assist device surgery, coronary bypass grafting. Devices were implanted via the percutaneous (n = 22) or surgical (n = 24) route.
  
  
  RESULTS
  No intraprocedural mortality was observed. Mean time from admission to CF-RVSD implantation was 5.7 ± 8.5 days, with a mean of 6,769 ± 789 rotations/min, providing 4.2 ± 1.3 l/min of flow. Mean duration of support was 5.4 ± 5.1 days. Mean arterial pressure (65 ± 12 mm Hg vs. 73 ± 14 mm Hg; p < 0.05), right atrial pressure (21 ± 8 mm Hg vs. 16 ± 7 mm Hg; p = 0.05), pulmonary artery systolic pressure (43 ± 15 mm Hg vs. 33 ± 15 mm Hg; p = 0.01), and cardiac index (1.7 ± 0.7 vs. 2.2 ± 0.6; p = 0.01) were improved within 48 h of CF-RVSD implantation. Total in-hospital mortality was 57% and was lowest in the setting of left ventricular assist device implantation, chronic left heart failure, and acute myocardial infarction. Increased age, biventricular failure, and Thrombolysis In Myocardial Infarction-defined major bleeding were associated with increased in-hospital mortality.
  
  
  CONCLUSIONS
  Use of the CF-RVSD for RVF is clinically feasible and associated with improved hemodynamic status. Observations from the registry of patients who have received this device may support the development of prospective studies that will examine the role of percutaneous circulatory support for RVF.
authors.affiliation: The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts. Electronic address: Nkapur@tuftsmedicalcenter.org.
authors.forename: Navin K
authors.initials: NK
authors.lastname: Kapur
authors.affiliation: The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Vikram
authors.initials: V
authors.lastname: Paruchuri
authors.affiliation: The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Anand
authors.initials: A
authors.lastname: Jagannathan
authors.affiliation: Interventional Cardiology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Daniel
authors.initials: D
authors.lastname: Steinberg
authors.affiliation: Interventional Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Anjan K
authors.initials: AK
authors.lastname: Chakrabarti
authors.affiliation: Interventional Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Duane
authors.initials: D
authors.lastname: Pinto
authors.affiliation: Division of Cardiology, Medstar Heart Institute, Washington, DC.
authors.forename: Nima
authors.initials: N
authors.lastname: Aghili
authors.affiliation: Division of Cardiology, Medstar Heart Institute, Washington, DC.
authors.forename: Samer
authors.initials: S
authors.lastname: Najjar
authors.affiliation: Interventional Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: John
authors.initials: J
authors.lastname: Finley
authors.affiliation: Cardiology, St. Francis Hospital, Roslyn, New York.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Orr
authors.affiliation: Interventional Cardiology, Northwestern University, Chicago, Illinois.
authors.forename: Michael
authors.initials: M
authors.lastname: Tempelhof
authors.affiliation: Division of Cardiology, Oregon Health Sciences University, Portland, Oregon.
authors.forename: James O
authors.initials: JO
authors.lastname: Mudd
authors.affiliation: The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kiernan
authors.affiliation: The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Duc Thinh
authors.initials: DT
authors.lastname: Pham
authors.affiliation: The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts.
authors.forename: David
authors.initials: D
authors.lastname: DeNofrio
mesh_terms: D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: invasive hemodynamics; mechanical circulatory support; right heart failure