Right Ventricular Failure After Implantation of Left Ventricular Assist Devices
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 83
- 试验地点
- 1
- 主要终点
- Right ventricular failure
研究概览
简要总结
The left ventricular assist device (LVAD) is a portable mechanical pump that helps the left side of the heart of patients with severe heart failure that are awaiting heart transplantation or are not transplant candidates. However, while LVAD supports the left side of the heart, the right side must work on its own. Sometimes the right side does not recover, a condition called right ventricular failure (RVF). This complication increases mortality, prolongs hospitalization, requires additional procedures, and increases costs. Several risk factors and scores have been proposed to identify patients at risk for RVF. However, these methods have proven inadequate; one out of three patients is still experiencing right ventricular failure after LVAD surgery.
Echocardiography, an established noninvasive method to see the heart without radiation or risk, has a lot of potential to identify patients at risk for RVF. The questions we will tray to answer with this American Heart Association funded project are:
- Can echocardiography before scheduled LVAD surgery predict who is going to develop RVF and poor quality of life so we can better select patients for LVAD surgery?
- Can echocardiography before scheduled LVAD surgery tell us the course of right ventricular function after implantation so we can potentially take additional measures and prevent RVF?
To answer these questions, we will record images of the heart with echocardiography before LVAD surgery in 120 LVAD recipients at Emory University. We will then follow the patients for 90 days to detect any symptoms and signs of clinical RVF and poor quality of life and record the course of right ventricular function with echocardiography.
Currently, it is estimated that 150,000 to 250,000 patients in US are potential LVAD recipients with 2,000 devices implanted in 2012. LVAD can improve survival and quality of life in suitable patients. However, implantation requires a major surgical procedure with associated risks and considerable resources. Thus, careful patient selection is necessary to minimize risk for patients and maximize benefit for patients and society. Our long-term goal is to use echocardiography as a tool to (1) optimally select patients for LVAD and offer alternatives to patients at increased risk for complications and (2) potentially, inform earlier LVAD implantation in patients with weakening right ventricular function.
详细描述
Despite (1) improved outcomes and lower rates of right ventricular failure (RVF) with the newer, continuous-flow left ventricular assist devices (LVAD) over pulsatile-flow devices and (2) development of clinical prediction scores to identify patients at risk for RVF post LVAD, RVF still occurs in 20% to 40% of recipients, even with the newer devices.
In 2012, 2000 LVADs were implanted in U.S. and the number is rapidly increasing. Post-LVAD outcomes depend critically on right ventricular (RV) function. RVF can lead to:
- Reduced survival and progression to transplant (Tx) and worse post-Tx outcomes
- Significantly higher rates of resources utilization
- Long-term poor exercise capacity and quality of life (QoL)
True echocardiographic quantification of RV function has only recently been considered in RVF prediction post LVAD; however these studies were retrospective and had inconsistent population and outcome definitions. Also, despite promising results in a retrospective study, preoperative RV mechanics have not been prospectively evaluated as RVF predictors to date.
In this study, we plan to enroll a total of 120 LVAD candidates to evaluate standard and mechanics-based echocardiographic measures of RV function for prediction of (1) RVF within 90 days; (2) QoL at 90 days; and (3) RV recovery at 90 days post LVAD implantation.
研究设计
- 研究类型
- Observational
- 观察模型
- Case Only
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 75 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age 18-75 years
- •Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Class 2-7
- •Willing to participate
- •Able to give consent
排除标准
- •INTERMACS Class 1
- •Pre-operative advanced RVF, defined as planned or anticipated need for RVAD or extracorporeal membrane oxygenation at surgery
- •Unresponsive pulmonary vascular resistance (PVR) >6 Wood units
结局指标
主要结局
Right ventricular failure
时间窗: 90 days
Right ventricular failure (RVF) at 90 days, defined as RVF-related death (multi-organ failure), need for inhaled nitric oxide postoperatively for ≥48h, need for post-operative inotropes for ≥14 days, reinstitution of inotropes beyond 14 days, or need for a RV assist device (RVAD)
次要结局
- Quality of life(90 days)
- Right ventricular recovery(30 and 90 days)
研究者
Kunal Bhatt
Assistant Professor
Emory University