Pre-operative atrial fibrillation and early right ventricular failure after left ventricular assist device implantation: a systematic review and meta-analysis - 09/07/21
Highlights |
• | Concomitant AF is prevalent amongst advanced HF patients undergoing LVAD implantation (38.8%) |
• | Pre-operative AF is not associated with higher risks of early post-operative RVF or the need for RVAD support after LVAD implantation |
• | The association of different AF phenotypes and management with risk of post-LVAD RVF needs further investigation |
Résumé |
Background |
Right ventricular failure (RVF) remains a major cause of morbidity and mortality after left ventricular assist device (LVAD). Atrial fibrillation (AF) is known for its deleterious effects on cardiac function and hemodynamics. The association of pre-operative AF with the risk of early post-LVAD RVF has not been well described.
Method |
A comprehensive literature search was performed through April, 9 2021. Cohort studies comparing the risk of post-operative RVF and/or need for right ventricular assist device (RVAD) after LVAD in patients with or without AF were included. Pooled odds ratio (OR) with 95% confidence intervals (CI) and I2 statistic were calculated using the random-effects model.
Results |
Six studies were included in the analysis. Post-operative RVF was reported in 5 studies (1,841 patients) and RVAD use was reported in 4 studies (1,355 patients). There is a non-significant trend toward a higher risk of post-operative RVF in the AF group (pooled OR=1.25, 95%CI=0.99-1.58). No significant association between AF and RVAD use is noted (pooled OR=1.17, 95%CI=0.82-1.66).
Conclusions |
Pre-operative AF is not significantly associated with higher risks of post-operative RVF and RVAD use after LVAD implantation, although the trend toward higher post-operative RVF is observed in patients with pre-operative AF. Additional research using a larger study population is warranted to better understand the association of pre-operative AF and the development of post-LVAD RVF.
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Keywords : None, ABBREVIATIONS: AF, Atrial fibrillation, BTT, Bridge to transplant, CI, Cardiac index, CVP, Central venous pressure, DT, Destination therapy, HF, Heart failure, LV, Left ventricle, LVAD, Left ventricular assist device, PAP, Pulmonary artery pressure, RV, Right ventricle, RVAD, Right ventricular assist device, RVF, Right ventricular failure
Plan
Vol 239
P. 120-128 - septembre 2021 Retour au numéro
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