title: Outcomes of patients with right ventricular failure on milrinone after left ventricular assist device implantation.
abstract: Previous studies have grouped together both patients requiring right ventricular assist devices (RVADs) with patients requiring prolonged milrinone therapy after left ventricular assist device (LVAD) implantation. We retrospectively identified 149 patients receiving LVADs and 18 (12.1%) of which developed right ventricular (RV) failure. We then separated these patients into those requiring RVADs versus prolonged milrinone therapy. This included 10 patients who were treated with prolonged milrinone and eight patients who underwent RVAD placement. Overall, the RV failure group had worse survival compared with the non-RV failure cohort (p = 0.038). However, this was only for the subgroup of patients who required RVADs, who had a 1, 6, 12, and 24 month survival of 62.5%, 37.5%, 37.5%, and 37.5%, respectively, versus 96.8%, 92.1%, 86.7%, and 84.4% for patients without RV failure (p < 0.001). Patients treated with prolonged milrinone therapy for RV failure had similar survivals compared with patients without RV failure. In the RV failure group, age, preoperative renal failure, and previous cardiac surgery were predictors of the need for prolonged postoperative milrinone. As LVADs become a more widely used therapy for patients with refractory, end-stage heart failure, it will be important to reduce the incidence of RV failure, as it yields significant morbidity and increases cost.
authors.affiliation: From the *Section of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut; and †Division of Cardiac Surgery, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Tsiouris
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paone
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Brewer
authors.forename: Hassan W
authors.initials: HW
authors.lastname: Nemeh
authors.forename: Jamil
authors.initials: J
authors.lastname: Borgi
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Morgan
mesh_terms: D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000009:adverse effects / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000188:drug therapy* / Q000209:etiology*
chemical_list: D002316:Cardiotonic Agents; D020105:Milrinone