TY - JOUR
T1 - Preoperative passive venous pressure-driven cardiac function determines left ventricular assist device outcomes
AU - Michigan Congestive Heart Failure Investigators
AU - Tang, Paul C.
AU - Millar, Jessica
AU - Noly, Pierre Emmanuel
AU - Sicim, Hüseyin
AU - Likosky, Donald S.
AU - Zhang, Min
AU - Pagani, Francis D.
AU - Haft, Jonathan W.
AU - Aziz Abou El Ela, Ashraf Shaaban Abdel
AU - Thompson, Michael P.
AU - Hawkins, Robert B.
AU - Colvin, Monica
AU - Naik, Suyash
AU - Shore, Supriya
AU - Cascino, Thomas
AU - McCullough, Jeffrey S.
AU - Chung, Grace
AU - Hou, Michelle
AU - Janda, Allison M.
AU - Mathis, Michael R.
AU - Watt, Tessa M.F.
AU - Yost, Gardner L.
AU - Airhart, Austin
AU - Liesman, Daniel
AU - Nassar, Khalil
AU - Aaronson, Keith D.
N1 - Publisher Copyright:
© 2023 The American Association for Thoracic Surgery
PY - 2024/7
Y1 - 2024/7
N2 - Background: Right heart output in heart failure can be compensated through increasing systemic venous pressure. We determined whether the magnitude of this “passive cardiac output” can predict LVAD outcomes. Methods: This was a retrospective review of 383 patients who received a continuous-flow LVAD at the University of Michigan between 2012 and 2021. Pre-LVAD cardiac output driven by venous pressure was determined by dividing right atrial pressure by mean pulmonary artery pressure, multiplied by total cardiac output. Normalization to body surface area led to the passive cardiac index (PasCI). The Youden J statistic was used to identify the PasCI threshold, which predicted LVAD death by 2 years. Results: Increased preoperative PasCI was associated with reduced survival (hazard ratio [HR], 2.27; P < .01), and increased risk of right ventricular failure (RVF) (HR, 3.46; P = .04). Youden analysis showed that a preoperative PasCI ≥0.5 (n = 226) predicted LVAD death (P = .10). Patients with PasCI ≥0.5 had poorer survival (P = .02), with a trend toward more heart failure readmission days (mean, 45.09 ± 67.64 vs 35.13 ± 45.02 days; P = .084) and increased gastrointestinal bleeding (29.2% vs 20.4%; P = .052). Additionally, of the 97 patients who experienced readmissions for heart failure, those with pre-LVAD implantation PasCI ≥0.5 were more likely to have more than 1 readmission (P = .05). Conclusions: Although right heart output can be augmented by raising venous pressure, this negatively impacts end-organ function and increases heart failure readmission days. Patients with a pre-LVAD PasCI ≥0.5 have worse post-LVAD survival and increased RVF. Using the PasCI metric in isolation or incorporated into a predictive model may improve the management of LVAD candidates with RV dysfunction.
AB - Background: Right heart output in heart failure can be compensated through increasing systemic venous pressure. We determined whether the magnitude of this “passive cardiac output” can predict LVAD outcomes. Methods: This was a retrospective review of 383 patients who received a continuous-flow LVAD at the University of Michigan between 2012 and 2021. Pre-LVAD cardiac output driven by venous pressure was determined by dividing right atrial pressure by mean pulmonary artery pressure, multiplied by total cardiac output. Normalization to body surface area led to the passive cardiac index (PasCI). The Youden J statistic was used to identify the PasCI threshold, which predicted LVAD death by 2 years. Results: Increased preoperative PasCI was associated with reduced survival (hazard ratio [HR], 2.27; P < .01), and increased risk of right ventricular failure (RVF) (HR, 3.46; P = .04). Youden analysis showed that a preoperative PasCI ≥0.5 (n = 226) predicted LVAD death (P = .10). Patients with PasCI ≥0.5 had poorer survival (P = .02), with a trend toward more heart failure readmission days (mean, 45.09 ± 67.64 vs 35.13 ± 45.02 days; P = .084) and increased gastrointestinal bleeding (29.2% vs 20.4%; P = .052). Additionally, of the 97 patients who experienced readmissions for heart failure, those with pre-LVAD implantation PasCI ≥0.5 were more likely to have more than 1 readmission (P = .05). Conclusions: Although right heart output can be augmented by raising venous pressure, this negatively impacts end-organ function and increases heart failure readmission days. Patients with a pre-LVAD PasCI ≥0.5 have worse post-LVAD survival and increased RVF. Using the PasCI metric in isolation or incorporated into a predictive model may improve the management of LVAD candidates with RV dysfunction.
KW - Fontan
KW - Youden J statistic
KW - clinical outcomes
KW - echocardiography
KW - left ventricular assist device
KW - right ventricular assist device
KW - right ventricular failure
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U2 - 10.1016/j.jtcvs.2023.07.019
DO - 10.1016/j.jtcvs.2023.07.019
M3 - Article
C2 - 37495169
AN - SCOPUS:85167966474
SN - 0022-5223
VL - 168
SP - 133-144.e5
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 1
ER -