ORIGINAL ARTICLES  CARDIAC PAPERS 

The Journal of Cardiovascular Surgery 2000 June;41(3):349-55

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Postinfarct refractory right ventricle: right ventricular exclusion. A possible option to mechanical cardiac support, in patients unsuitable for heart transplant

Kaul T. K., Kahn D. R.

From the Department of Cardiac Surgery Baptist Medical Center, Birmingham, Alabama, USA

Back­ground. ­Postbypass refrac­tory ­right ven­tricle (RRV) may ­develop due to ­right ven­tric­ular (RV) ­ischemia or infarc­tion. In ­cases ­with RV infarc­tion, ­recovery is ­often pro­longed and sal­vage ­rate is ­extremely ­poor. In ­this ret­ro­spec­tive ­study, we ­have exam­ined the ­role of ­right ven­tric­ular exclu­sion (RVE), as a pos­sible ­option to con­ven­tional ­weaning or ­bridging to ­heart trans­plant (B-HTX), in ­patients who ­were unsuit­able for ­heart trans­plant.
­Methods. ­During ­last 5 ­years, cumu­la­tive inci­dence of ­post­bypass refrac­tory cir­cu­la­tory ­failure (RCF) in our ­adult ­patients was 0.39% (26/6542). ­This ­problem was ­caused by a RRV in 17 (65%) ­patients. ­After ­CABG, ­these ­patients devel­oped a ­grossly dis­tended and ­poorly con­tracting RV (­RVEDV: 330-400 ml, ­RVEF: 0-10%), ­high cen­tral ­venous pres­sure (≥18 ­mmHg) and an inad­e­quate ­aortic pres­sure for ­weaning off car­di­o­pul­mo­nary ­bypass. ­Three ­patients, who ­were unac­cept­able for HTX ­under ­UNOS pro­gram (age >65 ­years), ­were ­weaned off ­bypass ­after RVE, and ­remaining ­patients ­with ­RVAD (n=3) or ­BiVAD sup­port, ­depending ­upon ­their con­com­i­tant mod­erate or ­poor ­left ven­tric­ular per­for­mance.
­Results. The sig­nif­i­cant pre­dic­tors of RRV by uni­var­iate anal­ysis ­were; 2nd or 3rd ­redo ­CABG for a ­recent myo­car­dial infarc­tion, and ­failed ­graft angio­plasty. Hos­pital mor­tality (14-60 ­days) was 0/3, 3/3 and 3/11 for the ­patients ­weaned off ­with RVE, ­RVAD and ­BiVAD respec­tively. At 3 ­years, ­overall sal­vage ­rate was 9/17 (RVE: 3/3, ­BiVAD B-HTX 4/6 + 2 ­weaned ­with ­BiVAD sup­port).
Con­clu­sion. ­Right ven­tric­ular exclu­sion is a pos­sible ­option to con­ven­tional B-HTX ­with mechan­ical sup­port, in ­patients who ­develop ­postinfarct RRV and are unsuit­able for trans­plant.