Mechanical circulatory supportRisk Score Derived from Pre-operative Data Analysis Predicts the Need for Biventricular Mechanical Circulatory Support
Section snippets
Patients
All 266 patients who underwent LVAD implantation at the Hospital of the University of Pennsylvania from April 1995 to June 2007 were retrospectively reviewed. Of these, 99 (37%) required RVAD support. The remaining 167 (63%) received isolated LVAD support, and it was these patients who comprised the study groups.
Devices
Multiple devices were used throughout the study period (Table 1, Table 2). These included the BioMedicus Perfusion System (Medtronic, Inc., Littleton, MA), TCI IP (Thermo Cardiosystems,
Univariate Analysis
Table 3 shows demographics and patient characteristics. BiVAD support was required more commonly for female patients (p = 0.0011) and those with smaller body surface area (BSA, p = 0.0029). Results of clinical factor comparisons are shown in Table 4. Severe pre-operative RV dysfunction, mechanical ventilation, previous cardiac surgery, use of an intra-aortic balloon pump (IABP), pre-operative mechanical circulatory support and non-separation from cardiopulmonary bypass were all present in
Discussion
The most effective treatment for end-stage heart failure is cardiac transplantation.27, 28 Discrepancy between the number of donors and those waiting for transplantation causes many potential recipients to die before transplantation, and yields lengthy waiting times for many who ultimately receive transplants. VADs have extended the time that moribund heart failure patients can survive while waiting for transplantation, and are also used successfully for long-term therapy.1, 2, 3, 4, 5, 6, 7, 8
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This work was funded by NIH grant HLO72812 (Y.J.W.), an ISHLT Research Fellowship (J.R.F.III) and NIH grant HLO7843 (J.R.F.).