Author + information
- Navin K. Kapur, MD∗∗ (, )
- Vikram Paruchuri, MD∗,
- Anand Jagannathan, MS∗,
- Daniel Steinberg, MD†,
- Anjan K. Chakrabarti, MD‡,
- Duane Pinto, MD‡,
- Nima Aghili, MD§,
- Samer Najjar, MD§,
- John Finley, MD‖,
- Nicole M. Orr, MD¶,
- Michael Tempelhof, MD#,
- James O. Mudd, MD∗∗,
- Michael S. Kiernan, MD∗,
- Duc Thinh Pham, MD∗ and
- David DeNofrio, MD∗
- ↵∗Reprint requests and correspondence:
Dr. Navin K. Kapur, Molecular Cardiology Research Institute, Division of Cardiology, Tufts Medical Center, 800 Washington Street, Box 80, Boston, Massachusetts 02111.
Objectives The aim of this study was to explore the clinical utility of a commercially available centrifugal flow pump as a centrifugal flow-right ventricular support device (CF-RVSD) in patients with right ventricular failure (RVF).
Background RVF is associated with high in-hospital mortality. Limited data regarding efficacy of the CF-RVSD for RVF exist.
Methods We retrospectively reviewed data from 46 patients receiving a CF-RVSD for RVF from a registry comprising data from 8 tertiary-care hospitals in the United States. CF-RVSD use was recorded in the setting of acute myocardial infarction; myocarditis; chronic left heart failure; after valve surgery, orthotopic heart transplantation, left ventricular assist device surgery, coronary bypass grafting. Devices were implanted via the percutaneous (n = 22) or surgical (n = 24) route.
Results No intraprocedural mortality was observed. Mean time from admission to CF-RVSD implantation was 5.7 ± 8.5 days, with a mean of 6,769 ± 789 rotations/min, providing 4.2 ± 1.3 l/min of flow. Mean duration of support was 5.4 ± 5.1 days. Mean arterial pressure (65 ± 12 mm Hg vs. 73 ± 14 mm Hg; p < 0.05), right atrial pressure (21 ± 8 mm Hg vs. 16 ± 7 mm Hg; p = 0.05), pulmonary artery systolic pressure (43 ± 15 mm Hg vs. 33 ± 15 mm Hg; p = 0.01), and cardiac index (1.7 ± 0.7 vs. 2.2 ± 0.6; p = 0.01) were improved within 48 h of CF-RVSD implantation. Total in-hospital mortality was 57% and was lowest in the setting of left ventricular assist device implantation, chronic left heart failure, and acute myocardial infarction. Increased age, biventricular failure, and Thrombolysis In Myocardial Infarction–defined major bleeding were associated with increased in-hospital mortality.
Conclusions Use of the CF-RVSD for RVF is clinically feasible and associated with improved hemodynamic status. Observations from the registry of patients who have received this device may support the development of prospective studies that will examine the role of percutaneous circulatory support for RVF.
Dr. Kapur has received pre-clinical research support from CardiacAssist Inc., the manufacturer of the TandemHeart right ventricular support device, and HeartWare Inc., as well as speaking honoraria from Maquet Inc. Dr. Steinberg has received consultant fees and/or honoraria from AstraZeneca, Boston Scientific, Medtronic, St. Jude's Hospital, and Terumo. Dr. Pinto is a consultant and on the advisory board of The Medicines Company and Medtronic; is a consultant for Merck and Boston Scientific; is on the Data and Safety Monitoring Board of Rox Medical, Lantheus, Genentech, and Covidien; has received research support from Covidien; is on the Clinical Events Committee for the Boston Clinical Research Institute; and has received author royalities from UpToDate. Dr. Najjar has received research support from HeartWare Inc. and Gambro. Dr. Pham has received pre-clinical research grants from CardiacAssist Inc.; and HeartWare Inc.; and is a consultant to Thoratec. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 24, 2013.
- Accepted January 30, 2013.
- American College of Cardiology Foundation