Neurohumoral and infl ammatory markers for prediction of right ventricular failure after implantation of a left ventricular assist device
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Felix Hennig, MD · Alexander V. Stepanenko, MD Hans B. Lehmkuhl, MD · Marian Kukucka, MD Michael Dandel, MD, PhD Thomas Krabatsch, MD, PhD Roland
- چاپ و سال / کشور: 2010
Description
Purpose. Implantation of a left ventricular assist device (LVAD) is an established treatment for end-stage heart failure. Right ventricular dysfunction develops in 20%.50% of patients after device implantation, leading to prolonged hospital stays and elevated mortality rates. However, prediction of right ventricular failure remains diffi cult. Methods. A total of 40 patients who received an LVAD for chronic end-stage heart failure between May 2001 and December 2002 were evaluated. The patients were divided retrospectively into two groups: group I (n = 26), with no apparent postoperative right ventricular failure; and group II (n = 14), with right ventricular failure after implantation defi ned by the presence of two of the following criteria during the fi rst week after surgery: mean arterial pressure .55 mmHg, central venous pressure .16 mmHg, mixed venous saturation .55%, cardiac index <2 l/min/m2, inotropic support score >20 units or an apparent need for mechanical right ventricular support. Hemodynamic, echocardiographic, neurohumoral, and infl ammatory parameters were evaluated 24 h before implantation of the LVAD. Results. Levels of procalcitonin, neopterin, n-terminalpro- brain natriuretic peptide, and big endothelin-1 were signifi cantly lower in group I: 0.106 vs. 0.322 ng/ml,P = 0.048; 10.5 vs. 20.7 ng/ml, P = 0.018; 6322 vs. 17174 pg/ml, P = 0.032; 1.6 vs. 19.5 pg/ml, P = 0.02, respectively. Levels of creatinine kinase and creatinine were signifi cantly lower in group I than in group II: 24 vs. 40 U/l, P = 0.034; 1.3 vs. 2.3 mg/dl, P = 0.008, respectively. Conclusion. Preoperative evaluation of markers of infl ammation and neurohumoral activation may provide additional information for predicting right ventricular failure after implantation of an LVAD.
Gen Thorac Cardiovasc Surg (2011) 59:19–24 DOI 10.1007/s11748-010-0669-9 Received: 1 December 2009 / Accepted: 8 July 2010
