scholarly journals Anesthetic protocol for right ventricular dysfunction management in heart transplantation: systematic review, development and validation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lucas Nepomuceno Barros ◽  
Ricardo Barreira Uchoa ◽  
Juan Alberto Cosquillo Mejia ◽  
Rogean Rodrigues Nunes ◽  
Denise Araujo Silva Nepomuceno Barros ◽  
...  
Keyword(s):  
Systematic Review ◽  
Heart Transplantation ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Exclusion Criteria ◽  
Agree Ii ◽  
Goal Directed Therapy ◽  
Potential Benefits ◽  
Development And Validation

Abstract Background Right Ventricular Dysfunction (RVD) is the most frequent intraoperative hemodynamic complication in Heart Transplantation (HTx). RVD occurs in 0.04–1.0% of cardiac surgeries with cardiotomy and in 20–50% of HTx, with mortality up to 75%. No consensus has been established for how anesthesiologists should manage RVD, with management methods many times remaining unvalidated. Methods We conducted a systematic review, following PRISMA guidelines, to create an anesthetic protocol to manage RVD in HTx, using databases that include PubMed and Embase, until September 2018 based on inclusion and exclusion criteria. The articles screening for the systematic review were done two independent reviewers, in case of discrepancy, we consulted a third independent reviewer. Based on the systematic review, the anesthetic protocol was developed. The instrument selected to perform the validation of the protocol was AGREE II, for this purpose expert anesthetists were recruited to do this process. The minimum arbitration score for domains validation cutoff of AGREE II is arbitered to 70%. This study was registered at PROSPERO (115600). Results In the systematic review, 152 articles were included. We present the protocol in a flowchart with six steps based on goal-directed therapy, invasive monitoring, and transesophageal echocardiogram. Six experts judged the protocol and validated it. Conclusion The protocol has been validated by experts and new studies are needed to assess its applicability and potential benefits on major endpoints.

scholarly journals Impact of right ventricular dysfunction after MitraClip treatment as a bridge to heart transplantation: insights from the MitraBridge registry

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Munafo ◽  
A Scotti ◽  
R Estevez-Loureiro ◽  
D Arzamendi ◽  
N.P Fam ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Right Ventricular ◽  
Primary Outcome ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
End Point

Abstract Background MitraClip treatment has been recently proposed as a “bridge strategy” solution for advanced heart failure (HF) patients with significant functional mitral regurgitation (MR), who are potential candidates or are waiting for cardiac replacement therapy (LVAD or heart transplantation, HTx). In this clinical scenario, left-ventricular-related right ventricular dysfunction (RVD) represents an important prognostic factor. Purpose Our study aimed to investigate the possible prognostic implication of RVD in advanced HF patients treated with MitraClip as a bridge to HTx strategy. Methods RVD was assessed using the relationship between tricuspid annular peak systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP). All patients from the MitraBridge registry for whom these two echocardiographic parameters were available, were included in the study. A cut-off value of TAPSE/PASP ratio <0.36 was used to defined RVD, as previously reported. The primary outcome was a composite end-point of all-cause death or rehospitalization for HF at 2-year. For patients who underwent LVAD implantation or HTx, follow-up data were censored at the time of those events. Results A total of 80 patients were included in the study. The median TAPSE/PASP ratio was 0.35 (25th-75th: 0.27–0.46), with 43 (54%) patients having a TAPSE/PASP ratio <0.36 (RVD group). The latter had a prevalent MR ischemic etiology (49% vs 38%), with a more frequent history of percutaneous coronary intervention (46.5% vs 22%, p=0.02). Except for TAPSE (15.7±3.6 mm vs 19.2±3.7 mm, p=0.001) and PASP (61±14 mmHg vs 39.5±9.5 mmHg, p<0.001), the other echocardiographic characteristics were similar between the two study groups (overall mean left ventricular ejection fraction 26.9±8%, median left ventricular end-diastolic volume index 120.7, 25th-75th: 102.2–146.5 mL/m2). After a median follow-up time of 508 (25th-75th: 160–899) days, elective HTx occurred in 12 patients (7 from the RVD group), while LVAD implantation was performed in 13 patients (7 from the RVD group). The primary outcome occurred in 30 patients (38%) with a 2-year Kaplan-Meier estimate of freedom from the composite end-point of 41%. At univariate (HR 1.3 95% CI 0.6–2.8, p=0.451) and multivariate (HR 1.6 CI 0.7–3.8, p=0.249) Cox-regression analysis, TAPSE/PASP ratio <0.36 was not identified as an independent predictor of primary outcome. Indeed, at follow-up echocardiographic control (median time 252, 25th-75th: 122–365 days), a significant improvement in TAPSE/PASP ratio was observed in the RVD group (baseline median TAPSE/PASP ratio 0.27, 25th-75th: 0.22–0.32 vs follow-up median TAPSE/PASP ratio 0.37, 25th-75th: 0.28–0.47, p<0.001). Conclusion In advanced HF patients with functional MR, MitraClip treatment could prevent or ameliorate left-ventricular-related RVD, allowing safe access to HTx or LVAD. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Planned right ventricular support for combined heart–liver transplantation

2019 ◽  
Vol 29 (6) ◽  
pp. 969-970
Author(s):  
Yaron D Barac ◽  
Sharon L McCartney ◽  
Debra Sudan ◽  
Jacob N Schroder
Keyword(s):  
Liver Transplantation ◽  
Heart Transplantation ◽  
Right Ventricular ◽  
Ventricular Assist Device ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Assist Device ◽  
Ventricular Assist ◽  
Ventricular Support ◽  
Right Ventricular Assist Device

Abstract Right ventricular dysfunction post heart transplantation (HTx) is a common problem and its likelihood to occur after combined heart–liver transplantation is even higher. The placement of an extracorporeal planned right ventricular assist device following the HTx during liver transplantation may assist in preventing this complication.

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