scholarly journals Prognostic Value of Natriuretic Peptides for All-Cause Mortality, Right Ventricular Failure, Major Adverse Events, and Myocardial Recovery in Advanced Heart Failure Patients Receiving a Left Ventricular Assist Device: A Systematic Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Eva Janssen ◽  
J. Wouter Jukema ◽  
Saskia L. M. A. Beeres ◽  
Martin J. Schalij ◽  
Laurens F. Tops
Keyword(s):  
Systematic Review ◽  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Myocardial Recovery ◽  
Ventricular Failure ◽  
Assist Device ◽  
Ventricular Assist ◽  
Severe Aortic Regurgitation ◽  
Left Ventricular Assist ◽  
All Cause Mortality

Aims: Major adverse event (MAE) rates during left ventricular assist device (LVAD) therapy in advanced heart failure (HF) patients are high, and impair quality of life and survival. Prediction and risk stratification of MAEs in order to improve patient selection and thereby outcome during LVAD therapy is therefore warranted. Circulating natriuretic peptides (NPs) are strong predictors of MAEs and mortality in chronic HF patients. However, whether NPs can identify patients who are at risk of MAEs and mortality or tend toward myocardial recovery after LVAD implantation is unclear. The aim of this systematic review is to analyze the prognostic value of circulating NP levels before LVAD implantation for all-cause mortality, MAEs and myocardial recovery after LVAD implantation.Methods and Results: Electronic databases were searched for studies analyzing circulating NP in adults with advanced HF before LVAD implantation in relation to mortality, MAEs, or myocardial recovery after LVAD implantation. Twenty-four studies published between 2008 and 2021 were included. Follow-up duration ranged from 48 hours to 5 years. Study sample size ranged from 14 to 15,138 patients. Natriuretic peptide levels were not predictive of all-cause mortality. However, NPs were predictive of right ventricular failure (RVF) and MAEs such as ventricular arrhythmias, moderate or severe aortic regurgitation, and all-cause rehospitalization. No relation between NPs and myocardial recovery was found.Conclusion: This systematic review found that NP levels before LVAD implantation are not predictive of all-cause mortality after LVAD implantation. Thus, NP levels may be of limited value in patient selection for LVAD therapy. However, NPs help in risk stratification of MAEs and may be used to identify patients who are at risk for RVF, ventricular arrhythmias, moderate or severe aortic regurgitation, and all-cause rehospitalization after LVAD implantation.

Mechanical Support of the Left Ventricle in Ischemia Induced Left Ventricular Failure: An Experimental Study

1992 ◽  
Vol 15 (2) ◽  
pp. 114-119 ◽  
Author(s):  
G. Zobel ◽  
D. Dacar ◽  
M. Kuttnig ◽  
S. Rödl ◽  
B. Rigler
Keyword(s):  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Left Ventricular Failure ◽  
Circulatory Support ◽  
Ventricular Failure ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
Effective System ◽  
And Control

Objective this study compares the hemodynamic effects of intraaortic balloon pumping (IABP), left ventricular assist device (LVAD), and extracorporeal membrane oxygenation (ECMO) in left ventricular failure in pigs. Methods In 29 pigs weighing 12 + 0.7 kg left ventricular failure was induced by ligating the left anterior descending coronary artery. Eight animals served as controls. Eight pigs were treated by IABP, seven by LVAD, and six by ECMO. The study period lasted four hours. Hemodynamic and oxygen transport/ uptake parameters were measured continuously or intermittently. Results Six animals of the ECMO and LVAD groups survived the 4 hour period, but only 3 and 4 animals of the IABP and control groups survived (p<0.05). Cardiac index decreased about 48% and 22% in the control and IABP groups (p<0.05), whereas there was only a slight decrease in the ECMO (9%) and LVAD (14%) groups. Oxygen delivery fell significantly in the control and IABP groups (p<0.05), compared with only a slight change in the LVAD and ECMO groups. Conclusion ECMO is the most effective system for temporary circulatory support in severe ventricular failure. LVAD maintains cardiac output when pulmonary blood flow is provided. IABP is less efficient in supporting the failing heart, especially in the presence of severe ventricular arrhythmias.

Abstract 16355: Impact of Renal Dysfunction on Outcomes After Left Ventricular Assist Device Implantation: A Systematic Review and Meta-analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michel Ibrahim ◽  
Sandrine Lebrun ◽  
Garly Rushler Saint Croix ◽  
Michael Fattouh ◽  
Sandra V Chaparro
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Renal Dysfunction ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Advanced Heart Failure ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
All Cause Mortality

Background: Renal dysfunction is a common comorbidity in patients with advanced heart failure who may benefit from left ventricular assist device (LVAD) therapy. The effect of preoperative renal dysfunction on clinical outcomes after LVAD implantation remains uncertain. We conducted a systematic review and meta-analysis to compare outcomes post-LVAD in patients with and without renal dysfunction. Methods: PubMed, Medline, and EMBASE databases were searched for studies comparing outcomes in patients with and without renal dysfunction who underwent LVAD implantation for advanced heart failure. The primary outcome of all-cause mortality was reported as random effects risk ratio (RR) with 95% confidence interval. Results: Our search yielded 5,229 potentially eligible studies. We included 7 studies reporting on 26,652 patients. Patients with renal dysfunction (glomerular filtration rate (GFR) <60) (n=4,630) were found to have increased risk of all-cause mortality 2.21 (95% CI 1.39-3.51, p <0.01) when compared to patients with normal renal function (GFR >60) (n=22,019). Conclusion: Patients with renal dysfunction have increased mortality after LVAD implantation when compared to patients with normal renal function. GFR can be used to risk stratify patients and guide decision making prior to LVAD therapy.

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