-
[show abstract]
[hide abstract]
ABSTRACT: We discussed clarification of research purposes and designing of data collection form in large clinical databases. Research purposes are 1)assessment of healthcare quality, 2)evaluation of diagnosis and treatment, and 3)evaluation of health policy. In designing clinical databases, the researchers should consider the following themes;assurance of clinical utility, international collaboration, alleviation of data entry burden and assurance of scientific accuracy.
Kyobu geka. The Japanese journal of thoracic surgery 05/2013; 66(5):401-405.
-
Teruhiko Imamura,
Koichiro Kinugawa,
Masaru Hatano,
Naoko Kato,
Shun Minatsuki,
Hironori Muraoka,
Toshiro Inaba,
Hisataka Maki,
Mitsutoshi Kimura,
Osamu Kinoshita,
Taro Shiga,
Atsushi Yao,
Shunei Kyo, Minoru Ono,
Issei Komuro
[show abstract]
[hide abstract]
ABSTRACT: There has been no established medical therapy to ameliorate pulmonary hypertension (PH) owing to left heart disease (LHD-PH). It has recently been shown that the left ventricular assist device (LVAD) can improve LHD-PH and therefore has the potential to become a major bridge tool for heart transplantation (HTx). However, some patients still have persistent PH even after LVAD treatment. It is essential to demonstrate the reversibility of end-organ dysfunction, including PH, prior to implantable LVAD treatment, especially in Japan, because implantable LVAD treatment is indicated only as bridge to transplantation. Here we report a patient with LHD-PH whose PH was demonstrated to be reversible by the acute pulmonary vasoreactivity test (APVT) with nitrogen monoxide (NO) and the phosphodiesterase-5 inhibitor sildenafil. Both inhaled NO and sildenafil reduced pulmonary vascular resistance, but pulmonary capillary wedge pressure was increased by NO, which was conversely decreased under increased cardiac output by sildenafil. After the patient was listed as an HTx recipient, pulmonary vascular resistance recovered down to an acceptable range with LVAD treatment. Based on these findings, we suggest that the APVT with sildenafil may be a useful and safe tool to predict improvement of PH after LVAD treatment.
Journal of Artificial Organs 04/2013; · 1.59 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Clinical database is a project aiming at quality improvement in medicine. It combines systematic collection of clinical data, analysis and feedback to medical practitioners. Medical professionals can clarify their challenges and deal with quality improvement based on feedback. Large and comprehensive clinicaldatabases have been founded in many countries recently. The databases can be used for various purposes;quality indicator, support tool for medical decision-making, policy decision-making and evaluation, clinical research and public reporting. Administrators must pay attention to scientific, ethical and political perspectives. In this manuscript, the authors discussed definitions and issues of large clinical databases.
Kyobu geka. The Japanese journal of thoracic surgery 04/2013; 66(4):325-30.
-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVES: To evaluate early outcomes of bilateral internal mammary artery (BIMA) compared with single IMA (SIMA) in patients who underwent isolated coronary artery bypass grafting (CABG). METHODS: Patients who received isolated CABG with SIMA or BIMA were retrospectively reviewed using the Japan Adult Cardiovascular Surgery Database from 210 institutions for 2008 and 2009. We performed a one-to-one matched analysis on the basis of estimated propensity scores for patients receiving either SIMA or BIMA and obtained two cohorts with 3851 patients in each group balanced for baseline characteristics out of 8136 SIMA and 4093 BIMA patients. We compared procedures actually performed, early outcomes including 30-day operative mortality and details of postoperative complications between the groups using Pearson's chi-square test, with P< 0.05 being statistically significant. RESULTS: Preoperative profiles in both groups included 20% females and 50% diabetes mellitus patients with a mean age of 67 years. Off-pump CABG was similar in both groups, being performed 75% of the time, with the mean number of anastomosis being 3.1 and 3.4 in the SIMA and BIMA groups, respectively (P< 0.0001). Thirty-day operative mortality was 1.2% in both groups, and the overall incidence of postoperative complications also was similar, although deep sternal infection was more frequent with BIMA (1.3 of SIMA and 2.3% of BIMA patients; P= 0.0001), while prolonged ventilation and renal failure were more frequent with SIMA (P< 0.05). CONCLUSIONS: The use of BIMA did not affect either short-term survival as postoperative mortality was low in both groups, or overall morbidity despite higher incidence of deep sternal infection.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 03/2013; · 2.40 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A 52-year-old man suffering from dilated cardiomyopathy underwent implantable left ventricular assist device (LVAD) insertion as a bridge to transplantation. He presented with evidence of LVAD-related mediastinitis and pump pocket infection 57 days after the LVAD implantation. The mediastinum was reopened and irrigated. A large amount of pus was observed around the outflow and inflow conduits and in the pump pocket. Negative pressure wound therapy (NPWT) was initiated. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from blood and mediastinal pus. Enterobacter cloacae was also isolated by mediastinal pus culture after the beginning of the NPWT. Three weeks after the start of the NPWT, the pus culture became negative, and omental transposition and sternal closure were performed. Intravenous antibiotics were administered until day 42, with the treatment subsequently switched to oral antibiotics. He was discharged from the hospital on day 57 and followed up at the outpatient clinic. Our findings suggest that NPWT followed by omental transposition be useful to treat mediastinitis or pump pocket infection after implantable LVAD insertion.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 03/2013;
-
[show abstract]
[hide abstract]
ABSTRACT: We report a case of aortic stenosis associated with ochronosis in a 70-year-old man who underwent biologic aortic valve replacement. Intraoperative findings included ochronosis of a severely calcified pigmented aortic valve along with pigmentation of the intima of the aorta.
The Annals of thoracic surgery 03/2013; 95(3):1076-9. · 3.74 Impact Factor
-
Akihide Umeki,
Takashi Nishimura,
Yoshiaki Takewa,
Masahiko Ando,
Mamoru Arakawa,
Yuichiro Kishimoto,
Tomonori Tsukiya,
Toshihide Mizuno,
Shunei Kyo, Minoru Ono,
Yoshiyuki Taenaka,
Eisuke Tatsumi
[show abstract]
[hide abstract]
ABSTRACT: Aiming the 'Bridge to Recovery' course, we have developed a novel left ventricular assist device (LVAD) controlling system. It can change the rotational speed of the continuous flow LVAD, EVAHEART, synchronized with the cardiac beat. Employing this system, we have already demonstrated that myocardial oxygen consumption (MVO2), which is considered to be equivalent to native heart load, changes in the hearts of normal goats. Herein, we examined changes in goats with acute ischemic heart failure. We studied 14 goats (56.1 ± 6.9 kg) with acute ischemic heart failure due to coronary microsphere embolization. We installed the EVAHEART and drive in four modes: "circuit-clamp", "continuous support", "counter-pulse", and "co-pulse", with 50 and 100 % bypass. In comparison to the circuit-clamp mode, MVO2 was reduced to 70.4 ± 17.9 % in the counter-pulse mode and increased to 90.3 ± 14.5 % in the co-pulse mode, whereas it was 80.0 ± 14.5 % in the continuous mode, with 100 % bypass (p < 0.05). The same difference was confirmed with 50 % bypass. This means that we may have a chance to change the native heart load by controlling the LVAD rotation in synchrony with the cardiac rhythm, so we named our controller as the Native Heart Load Control System (NHLCS). Employing changeable MVO2 with NHLCS according to the patient's condition may provide more opportunity for native heart recovery with LVAD, especially for patients with ischemic heart diseases.
Journal of Artificial Organs 01/2013; · 1.59 Impact Factor
-
Teruhiko Imamura,
Koichiro Kinugawa,
Naoko Kato,
Shun Minatsuki,
Hironori Muraoka,
Toshiro Inaba,
Hisataka Maki,
Taro Shiga,
Masaru Hatano,
Atsushi Yao,
Shunei Kyo, Minoru Ono,
Issei Komuro
[show abstract]
[hide abstract]
ABSTRACT: Chronic kidney disease (CKD) is often complicated with advanced heart failure because of not only renal congestion and decreased renal perfusion but also prolonged use of diuretics at higher doses, which sometimes results in hyponatremia. Preoperative CKD is known to be associated with poor prognosis after heart transplantation (HTx). We experienced a stage D heart failure patient with CKD and hyponatremia who was switched from trichlormethiazide to tolvaptan. His hyponatremia was normalized, and his renal function was improved after conversion to tolvaptan. In patients with stage D heart failure, it may be useful to administer tolvaptan with a concomitant reduction in the dose of diuretics in order to preserve renal function and avoid hyponatremia before HTx.
International Heart Journal 01/2013; 54(1):48-50. · 1.16 Impact Factor
-
Akihide Umeki,
Takashi Nishimura,
Masahiko Ando,
Yoshiaki Takewa,
Kenji Yamazaki,
Shunei Kyo, Minoru Ono,
Tomonori Tsukiya,
Toshihide Mizuno,
Yoshiyuki Taenaka,
Eisuke Tatsumi
[show abstract]
[hide abstract]
ABSTRACT: Background: A novel control system for the EVAHEART left ventricular assist device (LVAD), known as the Native Heart Load Control System (NHLCS), can change the device's rotational speed (RS) in synchrony with the heartbeat. The system enhanced coronary flow (CoF) with the counter-pulse mode in normal goats' hearts, so we examined the change in CoF in goats with acute ischemic heart failure (HF). Methods and Results: We studied 14 goats (56.1±6.9kg) with acute ischemic HF induced by coronary microsphere embolization. We installed EVAHEART and ran the device in 4 modes [continuous support, circuit-clamp, counter-pulse (raise RS in diastole), and co-pulse (raise RS in systole)] with 50% or 100% bypass in each mode. In comparison with the circuit-clamp mode, CoF was 121.0±14.1% in the counter-pulse mode and 102.9±7.9% in the co-pulse mode, whereas it was 113.5±10.6% in the continuous mode, with 100% bypass (P<0.05). The same difference was confirmed with 50% bypass. The results indicated that a LVAD in an acute ischemic heart enhanced CoF, and that CoF was greater in the counter-pulse mode and smaller in the co-pulse mode relative to the continuous mode. Conclusions: By using NHLCS to change CoF, recovery of native heart function with a LVAD has a better prognosis.
Circulation Journal 12/2012; · 3.77 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Heart failure continues to be a growing health problem, eluding large-scale improvement and treatment. Cardiac transplantation has been the gold standard treatment with high post-transplant survival rates and relatively good quality of life. However, there has been an extreme shortage of organ donations, limiting transplants to only a very small portion of patients with the condition. This led to a growing interest in alternative options for the increasing population of patients who are waitlisted or ineligible for transplantation. In recent years, ventricular assist device (VAD) technologies have advanced from pulsatile blood pumps to continuous-flow pumps that have demonstrated unprecedented post-implantation survival rates. The HeartMate II, the only commercially available, continuous flow left ventricular assist device (LVAD) in the United States and Europe, has been implanted in over 10,000 patients worldwide, setting a benchmark for biomedical modalities of advanced heart failure treatment. Thanks to the successes of contemporary LVADs, patients are able to enjoy a better lifestyle, with a significantly prolonged life span and the ability to regularly partake in physical activities. In this new biomedical generation, the usage of LVADs has begun to expand towards the treatment for a wider range of heart conditions, including earlier stages of heart failure. In fact, LVAD implantations have surpassed the number of transplants taken place annually. An increasing number of patients are considering the permanent, circulatory support with an LVAD, namely destination therapy, as a promising option for treating heart failure.
General Thoracic and Cardiovascular Surgery 12/2012;
-
[show abstract]
[hide abstract]
ABSTRACT: A neonate with tetralogy of Fallot and absent pulmonary valve presented with respiratory distress due to airway obstruction after birth. He was placed on mechanical respiration. At 28-days old, he underwent pulmonary artery reduction and pulmonary homograft insertion. Ventricular septal defect patch closure was performed under cardiopulmonary bypass. His postoperative course was complicated by prolonged mechanical ventilatory support because of tracheomalacia. After 1 year of follow-up, he was in good condition without pulmonary regurgitation.
Asian cardiovascular & thoracic annals 12/2012; 20(6):699-701.
-
Teruhiko Imamura,
Koichiro Kinugawa,
Masaru Hatano,
Naoko Kato,
Shun Minatsuki,
Hironori Muraoka,
Toshiro Inaba,
Hisataka Maki,
Taro Shiga,
Atsushi Yao,
Shunei Kyo, Minoru Ono,
Ryozo Nagai
[show abstract]
[hide abstract]
ABSTRACT: No medical treatment has been established to ameliorate pulmonary hypertension (PH) due to left heart disease. Heart transplantation (HTx) is thus far the definitive therapy for stage D heart failure, but concomitant PH is one of the major risk factors for death after HTx. Recently, implantation of a left ventricular assist device (LVAD) has been reported to improve PH and has become a major bridge tool for HTx. We experienced a rare case with persistent PH even after the implantation of a continuous-flow LVAD. The administration of an endothelin receptor antagonist, bosentan, significantly decreased pulmonary vascular resistance. Combination therapy with LVAD implantation and anti-PH medication may be useful for patients with stage D heart failure complicated with severe PH.
Journal of Artificial Organs 09/2012; · 1.59 Impact Factor
-
Teruhiko Imamura,
Koichiro Kinugawa,
Taro Shiga,
Miyoko Endo,
Naoko Kato,
Toshiro Inaba,
Hisataka Maki,
Masaru Hatano,
Atsushi Yao,
Takashi Nishimura,
Yasunobu Hirata,
Shunei Kyo, Minoru Ono,
Ryozo Nagai
[show abstract]
[hide abstract]
ABSTRACT: Background: It is often difficult to predict reversibility of liver or renal function after left ventricular assist device (LVAD) implantation in patients with stage D heart failure. Methods and Results: Data were obtained for 69 patients who had received a LVAD (18 continuous-flow, 51 pulsatile). Persistent hepatic or renal dysfunction was defined as levels of total bilirubin (TB) or creatinine (Cre) >1.5mg/dl at 6 months after LVAD implantation. TB score or Cre score was calculated: 0.15×age+1.1× (preoperative TB) or 0.2×age+3.6× (preoperative Cre), in which coefficients were determined on the basis of odds ratios for persistent hepatic or renal dysfunction, respectively. Receiver-operating characteristics analyses showed good predictabilities for persistent end-organ dysfunction (area under curve: 0.794 for TB score and 0.839 for Cre score). High-risk strata of TB score (>11.0 points) or Cre score (>14.1 points) were associated with persistently higher levels of TB or Cre (TB, 1.32±0.51; Cre, 1.23±0.41mg/dl; both P<0.001 vs. low-risk strata). Conclusions: Reversibility of end-organ function with LVAD implantation can be well predicted by our new risk scoring system that consists of the preoperative TB or Cre level adjusted by the patient's age. The scoring system would be beneficial, especially in considering the indication of a bridge to candidacy.
Circulation Journal 09/2012; · 3.77 Impact Factor
-
Yusuke Abe,
Kohei Ishii,
Takashi Isoyama,
Itsuro Saito,
Yusuke Inoue,
Toshiya Ono,
Hidemoto Nakagawa,
Emiko Nakano,
Kyoko Fukazawa,
Kazuhiko Ishihara,
Kazuyoshi Fukunaga, Minoru Ono,
Kou Imachi
[show abstract]
[hide abstract]
ABSTRACT: The helical flow pump (HFP) is a novel rotary blood pump invented for developing a total artificial heart (TAH). The HFP with a hydrodynamic levitation impeller, which consists of a multi-vane impeller involving rotor magnets, stator coils at the core position, and double helical-volute pump housing, was developed. Between the stator and impeller, a hydrodynamic bearing is formed. Since the helical volutes are formed at both sides of the impeller, blood flows with a helical flow pattern inside the pump. The developed HFP showed maximum output of 19 l/min against 100 mmHg of pressure head and 11 % maximum efficiency. The profile of the H-Q (pressure head vs. flow) curve was similar to that of the undulation pump. Hydrodynamic levitation of the impeller was possible with higher than 1,000 rpm rotation speed. The normalized index of the hemolysis ratio of the HFP to centrifugal pump (BPX-80) was from 2.61 to 8.07 depending on the design of the bearing. The HFP was implanted in two goats with a left ventricular bypass method. After surgery, hemolysis occurred in both goats. The hemolysis ceased on postoperative days 14 and 9, respectively. In the first experiment, no thrombus was found in the pump after 203 days of pumping. In the second experiment, a white thrombus was found in the pump after 23 days of pumping. While further research and development are necessary, we are expecting to develop an excellent TAH with the HFP.
Journal of Artificial Organs 08/2012; · 1.59 Impact Factor
-
Koichi Kashiwa,
Takashi Nishimura,
Aoi Nakahata,
Naoki Momose,
Chinori Umeda,
Hitoshi Kubo,
Hisayoshi Tamai,
Koichiro Kinugawa,
Hideo Adachi,
Atsushi Yamaguchi,
Tomoyuki Yambe,
Toshiyuki Katohgi,
Shunei Kyo, Minoru Ono
[show abstract]
[hide abstract]
ABSTRACT: We surveyed the incidence of blood pump diaphragm damage (rupture or crack) in the NIPRO-ventricular assist device (VAD). In the cases in which rupture or suspected blood pump crack was detected, we disassembled the pumps to visually check the condition of the diaphragm after replacement or use. Of 366 blood pumps surveyed, diaphragm damage was observed in 2.7 %. The duration of use of the blood pumps with diaphragm damage was significantly longer than that of pumps without damage. The incidence of diaphragm damage increased with longer duration of use. On the basis of these findings, blood pump diaphragm damage in the NIPRO-VAD may be associated with duration of use. However, some blood pumps were used for prolonged periods without diaphragm damage. All blood pumps with damage had a crack in the diaphragm on the air chamber side near the diaphragm-housing (D-H) junction. Cracks were not found in any specific part of the diaphragm. In blood pumps with diaphragm rupture, the crack had a through-hole reaching the blood-contacting surface. Although we were unable to identify the causes of the cracks, it is suggested that when a crack appears in the diaphragm it will gradually expand and eventually lead to rupture. If a crack is detected in a blood pump, we advocate replacing the pump before it grows. When the NIPRO-VAD is used, it is necessary to keep in mind that blood pump diaphragm damage may occur.
Journal of Artificial Organs 08/2012; · 1.59 Impact Factor
-
Taro Shiga,
Koichiro Kinugawa,
Teruhiko Imamura,
Naoko Kato,
Miyoko Endo,
Toshiro Inaba,
Hisataka Maki,
Masaru Hatano,
Atsushi Yao,
Takashi Nishimura,
Yasunobu Hirata,
Shunei Kyo, Minoru Ono,
Ryozo Nagai
[show abstract]
[hide abstract]
ABSTRACT: Background: Patients with biventricular assist device (BiVAD) placement have a poor prognosis, but preoperative risk factors for the necessity of BiVAD have not been fully elucidated. Methods and Results: Data from 79 patients who received left ventricular assist device (LVAD) between November 2002 and December 2011 were retrospectively reviewed. Overall, 9 patients (11.4%) required BiVAD, and the survival rate of BiVAD patients was significantly lower than that of LVAD patients (P<0.001). Multivariate analysis for BiVAD requirement showed left ventricular diastolic diameter (LVDd) ≤62mm (odds ratio [OR], 10.97; P=0.009) to be significantly associated with BiVAD requirement. Preoperative central venous pressure (CVP)/pulmonary capillary wedge pressure (PCWP) ratio ≥0.5 (OR, 13.09; P=0.028) was also significantly associated with BiVAD requirement. A new scoring system for predicting BiVAD requirement was created from the combination of CVP/PCWP ratio (≥0.5), body surface area (≤1.4m(2)), preoperative continuous hemodiafiltration use, B-type natriuretic peptide (≥1,200pg/ml) and LVDd (≤62mm), and this had a significantly larger area under the curve (0.909; P=0.003) than right ventricular stroke work index on receiver operating characteristic analysis. A score >20 using the new scoring method indicated significantly high probability of BiVAD requirement (OR, 16.00; P=0.019). Conclusions: The new scoring method, which includes CVP/PCWP ratio, is a novel risk stratification tool for BiVAD therapy.
Circulation Journal 08/2012; · 3.77 Impact Factor
-
Teruhiko Imamura,
Koichiro Kinugawa,
Taro Shiga,
Naoko Kato,
Miyoko Endo,
Toshiro Inaba,
Hisataka Maki,
Masaru Hatano,
Atsushi Yao,
Yasunobu Hirata,
Masaaki Akahane,
Takashi Nishimura,
Shunei Kyo, Minoru Ono,
Ryozo Nagai
[show abstract]
[hide abstract]
ABSTRACT: For the time being, in Japan, two recently approved implantable ventricular assist devices (VADs) are indicated only when a patient has been listed for heart transplantation or approved to be eligible for heart transplantation by in-hospital committee. The reversibility of end-organ dysfunction must be expected before VAD implantation, but it is often hard to prove during worsening clinical status. We report two patients whose end-organ dysfunction had been eventually demonstrated to be reversible by invasive procedures such as transluminal liver biopsy or transient insertion of intra-aortic balloon pumping.
Journal of Artificial Organs 07/2012; · 1.59 Impact Factor
-
Teruhiko Imamura,
Koichiro Kinugawa,
Taro Shiga,
Miyoko Endo,
Naoko Kato,
Toshiro Inaba,
Hisataka Maki,
Masaru Hatano,
Atsushi Yao,
Takashi Nishimura,
Yasunobu Hirata,
Shunei Kyo, Minoru Ono,
Ryozo Nagai
[show abstract]
[hide abstract]
ABSTRACT: Several groups have reported that an elevated ratio of early (E) to late (A) diastolic filling velocities is observed in patients after heart transplantation. However, the mechanism has not been fully analyzed.
Serial echocardiography and hemodynamic study were performed in 16 patients who had received heart transplantation and had no evidence of rejection during 1 month after the operation.
On Day 1 after the surgery, E/A ratio was higher and peak velocity of A wave was lower than normal range among the patients after heart transplantation. E/A ratio and peak velocity of A wave gradually normalized during 1 moth after the surgery. Meanwhile, early mitral annular velocity and pulmonary capillary wedge pressure remained within normal range during the study period.
Longer ischemic time during heart transplantation procedure may cause atrial stunning, but it appears to recover within 1 month. We have to be alert to misinterpretation of this "psuedo-psuedonormal" mitral inflow pattern early after transplantation.
Journal of Cardiology 06/2012; 60(4):295-300. · 1.28 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We report an 87-year-old woman with right ventricular perforation due to a permanent pacemaker lead detected 4-days after implantation. The pacemaker lead was seen to perforate through the myocardium and pericardium and to reach the left pleural cavity. We removed the wire surgically by median sternotomy. The pericardial effusion was cloudy and yellowish, suggesting infection. However, no bacteria were detected by bacterial cultures of the pericardial effusion and pacing wire. The patient developed neither mediastinitis nor sepsis after the operation, and a new pacemaker was implanted safely one month later.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 05/2012;
-
Teruhiko Imamura,
Koichiro Kinugawa,
Taro Shiga,
Miyoko Endo,
Naoko Kato,
Toshiro Inaba,
Hisataka Maki,
Masaru Hatano,
Atsushi Yao,
Takashi Nishimura,
Yasunobu Hirata,
Shunei Kyo, Minoru Ono,
Ryozo Nagai
[show abstract]
[hide abstract]
ABSTRACT: As we have previously reported, the preoperative profile defined by INTERMACS is a good predictor for the prognosis after left ventricular assist device (LVAD) implantation, but is largely dependent on the physician's decision. Several other risk stratification systems including objective parameters (eg, Leitz-Miller, Columbia, Seattle Heart Failure Model, APACHE II) have been proposed to estimate patient's mortality after LVAD implantation.
According to the preoperative data from 59 patients who received LVAD (10 implantable, 49 extracorporeal) since 2002 through 2010, we performed a logistic analysis and constructed a new scoring system (ie, the TODAI VAD score (TVAD score), assigning 8 points to serum albumin <3.2mg/dl (odds ratio [OR] 8.475), 7 points to serum total bilirubin >4.8mg/dl (OR 7.300), 6 points to left ventricular end-diastolic diameter <55mm (OR 5.917), 5 points to central venous pressure >11mmHg (OR 5.128)). The receiver-operating characteristic analysis showed that the area under the curve of our new scoring system (0.864) was significantly larger than any of the abovementioned 5 scoring methods (all P<0.05). With the TVAD score, low (0-8 points), intermediate (9-17 points), and high (18-26 points) risk strata had significantly different 1-year survival rates of 95%, 54%, and 14%, respectively (all P<0.001).
The TVAD score can predict the prognosis after LVAD implantation much better than the previously known methods.
Circulation Journal 05/2012; 76(8):1895-903. · 3.77 Impact Factor
