+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Right ventricular dysfunction during intensive pharmacologic unloading persists after mechanical unloading

Right ventricular dysfunction during intensive pharmacologic unloading persists after mechanical unloading

Journal of Cardiac Failure 16(3): 218-224

Right ventricular (RV) dysfunction is associated with adverse outcomes in heart failure (HF). Mechanical unloading should be more effective than pharmacologic therapy to reduce RV afterload and improve RV function. We compared RV size and function after aggressive medical unloading therapy to that achieved in the same patients after 3 months of left ventricular assist device (LVAD) support. We studied 20 patients who underwent isolated LVAD placement (9 pulsatile and 11 axial flow). Echocardiograms were performed after inpatient optimization with diuretic and inotropic therapy and compared with studies done after 3 months of LVAD support. After medical optimization right atrial pressure was 11 +/- 5 mm Hg, mean pulmonary artery pressure 36 +/- 11 mm Hg, pulmonary capillary wedge pressure 23 +/- 9 mm Hg, and cardiac index 2.0 +/- 0.6 L.min.m(2). Preoperatively, RV dysfunction was moderate (2.6 +/- 0.9 on a 0 to 4 scale), RV diameter at the base was 3.1 +/- 0.6 cm, and mid-RV was 3.5 +/- 0.6 cm. After median LVAD support of 123 days (92 to 170), RV size and global RV dysfunction (2.6 +/- 0.9) failed to improve, despite reduced RV afterload. RV dysfunction seen on intensive medical therapy persisted after 3 months of LVAD unloading therapy. Selection of candidates for isolated LV support should anticipate persistence of RV dysfunction observed on inotropic therapy.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 055575134

Download citation: RISBibTeXText

PMID: 20206896

DOI: 10.1016/j.cardfail.2009.11.002

Related references

Mechanical unloading of tower silos; results of tests with two types of unloading equipment. L'Italia agricola: 110 (10) 1193-1208, 1973

Left ventricular unloading during veno-arterial ECMO: a review of percutaneous and surgical unloading interventions. Perfusion 34(2): 98, 2019

Paradoxical Mechano-Energetic Costs of Acute Mechanical Intra-Ventricular Unloading: A Key to Understand Myocardial Recovery with Left-Ventricular Mechanical Support?. Journal of Heart and Lung Transplantation 36(4): S379-S380, 2017

Ito and IR potassium channel expression and regulation during severe left ventricular dysfunction and ventricular unloading. Journal of Heart & Lung Transplantation 22(1S): S200, 2003

Chronic septal infarction confers right ventricular protection during mechanical left ventricular unloading. Journal of Thoracic and Cardiovascular Surgery 138(1): 172-178, 2009

Left ventricular mechanical support with Impella provides more ventricular unloading in heart failure than extracorporeal membrane oxygenation. Asaio Journal 57(3): 169-176, 2011

Effect of mechanical unloading of left ventricle on right ventricular remodeling. Journal of Heart & Lung Transplantation 22(1S): S199-S200, 2003

Effects of mechanical left ventricular unloading on endothelin-1 release and apoptosis. Journal of the American College of Cardiology 43(5 Suppl. A): 263A-264A, 2004

Effect of mechanical ventricular unloading on mast cells in failing myocardium. Journal of Heart & Lung Transplantation 22(1S): S210, 2003

Mechanical left ventricular unloading to prevent recurrent myocardial rupture. Journal of Thoracic and Cardiovascular Surgery 140(1): E16-E17, 2010

Mitral valve prolapse after long-term mechanical ventricular unloading. Journal of Heart and Lung Transplantation 30(9): 1067-1068, 2011

Myocardial recovery by mechanical unloading with left ventricular assist system. Circulation Journal 73(8): 1386-1392, 2009

Myocardial sympathetic innervation and long-term left ventricular mechanical unloading. Jacc. Cardiovascular Imaging 3(1): 64-70, 2010

Expression and significance of β adrenergic receptors in a model of left ventricular mechanical unloading. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 23(7): 405-408, 2011

Changes in plasma N-terminal proBNP levels and ventricular filling pressures during intensive unloading therapy in elderly with decompensated congestive heart failure and preserved left ventricular systolic function. Journal of Cardiac Failure 12(8): 608-615, 2006