title: Pulmonary Bleeding During Right Ventricular Support After Left Ventricular Assist Device Implantation.
abstract: OBJECTIVE
  Right heart failure still occurs in up to 20% of patients after implantation of a left ventricular assist device (LVAD). One treatment option for these patients is the implantation of a temporary right ventricular assist device (RVAD). Experimental data suggest that non-pulsatile perfusion of the lungs is associated with an increased rate of pulmonary hemorrhage. The aim of this study was to determine the incidence of pulmonary bleeding complications in these patients.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Single center, university hospital.
  
  
  METHODS
  This study included patients undergoing LVAD implantation for end-stage heart failure and subsequent implantation of a temporary right ventricular support system.
  
  
  METHODS
  In this study, 25 patients who underwent LVAD and additional temporary RVAD implantation were screened for pulmonary bleeding complications.
  
  
  RESULTS
  The mean Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level at the time of LVAD implantation was 2.84. All patients experienced severe right ventricular failure (tricuspid annular plane systolic excursion [TAPSE], 10.16±26.3 mm) and severe pulmonary hypertension (right atrial [RA] pressure, 56.21±15.58 mmHg). Average duration of right ventricular support was 11.12±7.20 days, with right ventricular support being administered to 14 patients for more than 7 days. Seventeen patients were weaned successfully from right ventricular support after a mean support duration of 5 days. Five patients developed pulmonary bleeding complications, diagnosed using computed tomography scan and bronchoscopy. All bleeding occurred after postoperative day 7 and was associated with RVAD flow of more than 4 L/min within 24 hours before bleeding occurred.
  
  
  CONCLUSIONS
  The data presented in this study suggested that right ventricular support for more than 7 days and a blood flow greater than 4 L/min were associated with pulmonary bleeding complications. This should be taken into consideration when temporary right ventricular support after LVAD implantation is planned.
authors.affiliation: Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany. Electronic address: henryk.welp@ukmuenster.de.
authors.forename: Henryk
authors.initials: H
authors.lastname: Welp
authors.affiliation: Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany.
authors.forename: Jürgen R
authors.initials: JR
authors.lastname: Sindermann
authors.affiliation: Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Deschka
authors.affiliation: Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Martens
authors.affiliation: Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany.
authors.forename: Mirela
authors.initials: M
authors.lastname: Scherer
mesh_terms: D000328:Adult; D000368:Aged; D001999:Bronchoscopy; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D014057:Tomography, X-Ray Computed
keywords: LVAD; RVAD; bleeding; circulatory support devices; extracorporeal membrane oxygenation; lung; right ventricular support; temporary circulatory support