Predictors of right ventricular failure after left ventricular assist device implantation

Number of left ventricular assist device (LVAD) implantations increases every year, particularly LVADs for destination therapy (DT). Right ventricular failure (RVF) has been recognized as a serious complication of LVAD implantation. Reported incidence of RVF after LVAD ranges from 6% to 44%, varying mostly due to differences in RVF definition, different types of LVADs, and differences in patient populations included in studies. RVF complicating LVAD implantation is associated with worse postoperative mortality and morbidity including worse end-organ function, longer hospital length of stay, and lower success of bridge to transplant (BTT) therapy. Importance of RVF and its predictors in a setting of LVAD implantation has been recognized early, as evidenced by abundant number of attempts to identify independent risk factors and develop RVF predictor scores with a common purpose to improve patient selection and outcomes by recognizing potential need for biventricular assist device (BiVAD) at the time of LVAD implantation. The aim of this article is to review and summarize current body of knowledge on risk factors and prediction scores of RVF after LVAD implantation. Despite abundance of studies and proposed risk scores for RVF following LVAD, certain common limitations make their implementation and clinical usefulness questionable. Regardless, value of these studies lies in providing information on potential key predictors for RVF that can be taken into account in clinical decision making. Further investigation of current predictors and existing scores as well as new studies involving larger patient populations and more sophisticated statistical prediction models are necessary. Additionally, a short description of our empirical institutional approach to management of RVF following LVAD implantation is provide

Measurement of malondialdehyde (MDA) level in rat plasma after simvastatin treatment using two different analytical methods

Background and Purpose: The aim of this study was to investigate the effect of chronic administration of simvastatin (SIMV) on plasma malondialdehyde (MDA) level using two different methods. We also wanted to examine the plasma MDA level 10 days after the last administration of SIMV. Materials and Methods: The first two groups ofWistar rats were given 10 mg/kg/day of SIMV and the third and fourth groups 50 mg/kg/day of SIMV for 21 days. Two control groups were on saline for the same period. Plasma MDA level was measured after the end of treatment and 10 days after the last dose. Two methods were used: UV-VIS spectrophotometric method and HPLC-MS method. Statistics: Kruskal-Wallis test and Steel test for post-hoc comparison with the control group. P values less or equal to 0.05 were considered as statistically significant. Results:MDA levels in all groups,measured by both techniques, showed that SIMV treatment caused a dose-dependent decrease (significant in high dose) in plasma MDA level. The decrease in MDA level was also wellmaintained for 10 days after the last administration of SIMV in both doses (significantly in high dose). Conclusion: Both doses of SIMV decreased plasma MDA level after 21 day treatment and it remained decreased 10 days after the last dose, regardless of the measurement method used. These results showed that SIMV has antioxidant activity that persists after discontinuation of therap

Aortic valve cusp repair does not affect durability of modified aortic valve reimplantation for tricuspid aortic valvesCentral MessagePerspective

Objective: During aortic valve reimplantation, cusp repair may be needed to produce a competent valve. We investigated whether the need for aortic valve cusp repair affects aortic valve reimplantation durability. Methods: Patients with tricuspid aortic valves who underwent aortic valve reimplantation from January 2002 to January 2020 at a single center were retrospectively analyzed. Propensity matching was used to compare outcomes between patients who did and did not require aortic valve cusp repair. Results: Cusp repair was performed in 181 of 756 patients (24%). Patients who required cusp repair were more often male, were older, had more aortic valve regurgitation, and less often had connective tissue disease. Patients who underwent cusp repair had longer aortic clamp time (124 ± 43 minutes vs 107 ± 36 minutes, P = .001). In-hospital outcomes were similar between groups and with no operative deaths. A total of 98.3% of patients with cusp repair and 99.3% of patients without cusp repair had mild or less aortic regurgitation at discharge. The median follow-up was 3.9 and 3.2 years for the cusp repair and no cusp repair groups, respectively. At 10 years, estimated prevalence of moderate or more aortic regurgitation was 12% for patients with cusp repair and 7.0% for patients without cusp repair (P = .30). Mean aortic valve gradients were 6.2 mm Hg and 8.0 mm Hg, respectively (P = .01). Ten-year freedom from reoperation was 99% versus 99% (P = .64) in the matched cohort and 97% versus 97%, respectively (P = .30), in the unmatched cohort. Survival at 10 years was 98% after cusp repair and 93% without cusp repair (P = .05). Conclusions: Aortic valve reimplantation for patients with tricuspid aortic valves has excellent long-term results. Need for aortic valve cusp repair does not affect long-term outcomes and should not deter surgeons from performing valve-sparing surgery