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Liberal Right Ventricular Assist Device Extracorporeal Membrane Oxygenation Support for Right Ventricular Failure after Implantable Left Ventricular Assist Device Placement

Fischer, Quentin*,†; Kirsch, Matthias

doi: 10.1097/MAT.0000000000000735
Adult Circulatory Support

Refractory right ventricular failure (RVF) after implantation of left ventricular assist device (LVAD) is a dramatic complication. The addition of right ventricular assist device (RVAD) may improve RV recovery and lead to improve outcomes. From February 2012 to September 2014, 44 patients received a HeartMate II. These patients were retrospectively compared in two groups according to early liberal implantation of an extracorporeal membrane oxygenation (ECMO) used as a RVAD established between a femoral vein and the pulmonary artery. Of the 44 patients, 22 required addition of a temporary RVAD (t-RVAD group). Patients are sicker in the t-RVAD group with significantly higher rate of preoperative extracorporeal life support (46% vs. 9%; p = 0.016) or any mechanical circulatory support (55% vs. 14%; p = 0.01), more preoperative hemofiltration (23% vs. 0%; p = 0.048), and more inotrope support by dobutamine (68.2% vs. 27.3%; p = 0.015). Likewise Michigan risk score was significantly higher in t-RVAD group (2.61 ± 2.2 vs. 1.0 ± 1.6 pts; p = 0.013) and INTERMACS clinical profile (2.1 ± 0.6 vs. 3.4 ± 1.3 pts; p = 0.0001). Despite severity of preimplant conditions in t-RVAD group, clinical outcomes did not differ in both groups with similar survival rate at 6 months (60.4 ± 12 vs. 71.4 ± 9.9%; p = 0.585). Early and liberal use of temporary RVAD in patients with risk factors of RVF could improve the prognostic after LVAD implantation.

From the *Department of Cardiology, AP-HP Bichat Hospital, Paris, France

Cardiology, University Paris-Diderot, Sorbonne Paris-Cité, Paris, France

Department of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Submitted for consideration July 2017; accepted for publication in revised form October 2017.

Disclosure: Matthias Kirsch is a consultant for the Thoratec Corporation.

Correspondence: Quentin Fischer, MD, Cardiologie, Université Paris Diderot, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France. Email: q.fischer75@gmail.com.

Copyright © 2018 by the American Society for Artificial Internal Organs