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We are looking forward to welcoming Dr. Jennifer Cowger @preventfailure @HenryFordNews to our HF Grand Rounds conference @UHhospitals @CWRUSOM.
"Respecting the RV: What have we learned about management from LVAD patients?" Dr. Cowger @preventfailure Director of MCS at Henry Ford. Introductory comments by Dr. ElAmm "passionate teacher and researcher."
"Most of my career has been spent on caring for patients LVADs... RV the Achilles heel of LVAD therapy."
We learned that Jennifer Cowger is from Akron, OH!!
Overview of the talk.
For patients who need temporary RV support after LVAD, their survival at 1-year is only 50%. @preventfailure
Delayed RV failure after LVAD is associated with worse outcomes, including worse quality of life. @preventfailure
This is interesting! RV dysfunction after #TAVR is also associated with worse outcomes. @preventfailure What can we learn from RVF after TAVR as it relates to #LVAD therapy?
A similar theme demonstrated here with patients undergoing t-MVR. RV dysfunction is associated with worse outcomes. @preventfailure "As a HF specialist we spend so much time stratifying risk... the RV drives the mortality even higher." Dr. Cowger
RV and LV are not identical twins!! :) @preventfailure
Embryological development of the RV. Dr. Cowger @preventfailure is back to the basics!!! RV/LV exposed to different signals during development. Diff transcription factors impact RV/LV development. This leads to difft distribution of receptors/response to pharmacological agents.
Fascinating basic science! When the LV is infarcted, there is an upregulation of receptors in the RV. @preventfailure
RV and LV fiber morphology differs. "The septum is a helix, but in the RV they are longitudinal." @preventfailure (I think I got this right...).
The RV pressure-volume loop is completely different than the LV. "That little puny thing down here." @preventfailure I can see why it doesn't take much to destabilize it.
"The RV very quickly gives out and can't handle acute afterload elevation." @preventfailure
Processes of remodeling in chronic pulmonary hypertension. @preventfailure (I wish I could capture the fascinating stuff Jennifer is saying...!)
The RV has low capillary density because usually, the CPP is sufficient to sufficiently perfuse. @preventfailure
Art by Dr. Cowger: Here is what can happen post-op to the RV, and the subsequent cascades. @preventfailure -- HF GRs @UHhospitals
"My concern is that with time the LVAD can lead to the RV to enlarge... especially with some of the newer generation devices." Dr. Cowger @preventfailure -- HF GRs @UHhospitals @CWRUSOM
"HF doctors love formulas... love to predict how the RV will do after intervention." @preventfailure
Do not rely on RVF risk scores... "they're all pretty bad." @preventfailure
Jennifer's tips on managing the RV pre- and post-op LVAD. @preventfailure
Determine chronicity, treat underlying causes, reduce RV wall stress, improve RV inotropy, avoid interventions that will precipitate further RVF. @preventfailure Dr. Cowger, HF GRs @UHhospitals
Cowger's Recommendations: everyone gets RHC before procedure and set RA/PA/Wedge goals; Focus on RV post procedure; Don't over-rely on beta-agonists (RV is deficient in receptors!) embrace low dose alpha support; do not delay RVAD post LVAD; GDMT must continue. @preventfailure
