Combination evaluation of preoperative risk indices predicts requirement of biventricular assist device
2012 (English)In: Circulation Journal, ISSN 1346-9843, E-ISSN 1347-4820, Vol. 76, no 12, 2785-2791 p.Article in journal (Refereed) Published
Patients with biventricular assist device (BiVAD) placement have a poor prognosis, but preoperative risk factors for the necessity of BiVAD have not been fully elucidated.
METHODS AND RESULTS:
Data from 79 patients who received left ventricular assist device (LVAD) between November 2002 and December 2011 were retrospectively reviewed. Overall, 9 patients (11.4%) required BiVAD, and the survival rate of BiVAD patients was significantly lower than that of LVAD patients (P<0.001). Multivariate analysis for BiVAD requirement showed left ventricular diastolic diameter (LVDd) ≤62 mm (odds ratio [OR], 10.97; P=0.009) to be significantly associated with BiVAD requirement. Preoperative central venous pressure (CVP)/pulmonary capillary wedge pressure (PCWP) ratio ≥0.5 (OR, 13.09; P=0.028) was also significantly associated with BiVAD requirement. A new scoring system for predicting BiVAD requirement was created from the combination of CVP/PCWP ratio (≥0.5), body surface area (≤1.4 m(2)), preoperative continuous hemodiafiltration use, B-type natriuretic peptide (≥1,200 pg/ml) and LVDd (≤62 mm), and this had a significantly larger area under the curve (0.909; P=0.003) than right ventricular stroke work index on receiver operating characteristic analysis. A score >20 using the new scoring method indicated significantly high probability of BiVAD requirement (OR, 16.00; P=0.019).
The new scoring method, which includes CVP/PCWP ratio, is a novel risk stratification tool for BiVAD therapy.
Place, publisher, year, edition, pages
Japanese Circulation Society , 2012. Vol. 76, no 12, 2785-2791 p.
Heart failure; Right ventricular dysfunction; Stage D; Transplantation
IdentifiersURN: urn:nbn:se:liu:diva-111192DOI: 10.1253/circj.CJ-12-0231ISI: 000311765000014PubMedID: 22878403OAI: oai:DiVA.org:liu-111192DiVA: diva2:754492
Funding Agencies|FUGAKU trust for medicinal research; Japan Society for the Promotion of Science ; Japan Society for the Promotion of Science (JSPS) through Funding Program for World-Leading Innovative RandD on Science and Technology (FIRST Program)2014-10-102014-10-102014-10-20Bibliographically approved