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- Title
Right ventricular failure following left ventricular assist device implantation is associated with a preoperative pro-inflammatory response.
- Authors
Tang, Paul C.; Haft, Jonathan W.; Romano, Matthew A.; Bitar, Abbas; Hasan, Reema; Palardy, Maryse; Aaronson, Keith D.; Pagani, Francis D.
- Abstract
<bold>Background: </bold>Systemic inflammation during implant of a durable left ventricular assist device (LVAD) may contribute to adverse outcomes. We investigated the association of the preoperative inflammatory markers with subsequent right ventricular failure (RVF).<bold>Materials and Methods: </bold>Prospective data was collected on 489 patients from 2003 through 2017 who underwent implantation of a durable LVAD. Uni- and multivariable correlation with leukocytosis was determined using linear and binary logistic regression. The population was also separated into low (< 10.5 K/ul, n = 362) and high (> 10.5 K/ul, n = 127) white blood cell count (WBC) groups. Mantel-Cox statistics was used to analyze survival data.<bold>Results: </bold>Postop RVF was associated with a higher preop WBC (11.3 + 5.7 vs 8.7 + 3.1) and C-reactive protein (CRP, 5.6 + 4.4 vs 3.3 + 4.7) levels. Multivariable analysis identified an independent association between increased WBC preoperatively with increased lactate dehydrogenase (LDH, P < 0.001), heart rate (P < 0.001), CRP (P = 0.006), creatinine (P = 0.048), and INR (P = 0.049). The high WBC group was more likely to be on preoperative temporary circulatory support (17.3% vs 6.4%, P < 0.001) with a trend towards greater use of an intra-aortic balloon pump (55.9% vs 47.2%, P = 0.093). The high WBC group had poorer mid-term survival (P = 0.042).<bold>Conclusions: </bold>Postop RVF is associated with a preoperative pro-inflammatory environment. This may be secondary to the increased systemic stress of decompensated heart failure. Systemic inflammation in the decompensated heart failure may contribute to RVF after LVAD implant.
- Subjects
HEART assist devices; HEART failure; RIGHT heart ventricle diseases; LEFT heart ventricle; INFLAMMATION; PREOPERATIVE period; CARDIOVASCULAR diseases risk factors; HEART ventricle diseases; ARTIFICIAL blood circulation; C-reactive protein; RIGHT heart ventricle; INTRA-aortic balloon counterpulsation; LONGITUDINAL method; PROGNOSIS; RETROSPECTIVE studies; LEUKOCYTE count; SYSTEMIC inflammatory response syndrome; BLOOD; DISEASE complications
- Publication
Journal of Cardiothoracic Surgery, 2019, Vol 14, Issue 1, pN.PAG
- ISSN
1749-8090
- Publication type
journal article
- DOI
10.1186/s13019-019-0895-x