Evaluation of Predictive Factors for Right Ventriculaire Dysfunction
Evaluation of Predictive Factors for Right Ventriculaire Dysfunction
An observational study of patients in cardiogenic shock under veno-arterial ECMO is designed
 to describe the clinical, ultrasound and hemodynamic parameters of these patients and to
 establish a predictive score for right-sided dysfunction in a patient within 48 hours of ECMO
 withdrawal after placement of IMPELLA®.
Therapeutic innovations in the field of heart failure are constant and have improved the
 prognosis and quality of life of patients. For those suffering from end-stage heart failure,
 heart transplantation remains the main therapeutic resource, but on the one hand the number
 of available grafts is insufficient compared to the number of transplant candidates, and on
 the other hand heart transplantation is accompanied by risks of rejection, infections and
 cancers, with a current median survival of 12 years .

 For these reasons, in selected patients, a Left Ventricular Assist Device (LVAD) may be a
 bridge to transplantation or a way to improve the duration and quality of life of patients
 without a transplant project (destination therapy). Currently, about half of all heart
 transplants performed internationally are done in patients with left monoventricular assist,
 and in 2017 43% of implanted LVAD patients were in destination therapy.

 For this reason, this observational study aims to describe the clinical, ultrasound and
 hemodynamic parameters of these patients and to establish a predictive score for right-sided
 dysfunction in a patient during the 30-day follow-up.

 More precisely, during this study we will compare the clinical, ultrasound and hemodynamic
 parameters of these patients in order to establish a predictive score for right-sided
 dysfunction during :

 -  48 hours on ECMO and IMPELLA (after IMPELLA® placement)

 -  48 hours on IMPELLA alone following ECMO withdrawal.

 -  48 hours under left monoventricular assistance

 -  At day 7 of the follow-up

 -  At day30 of the follow-up Patients who develop right heart failure within 48 hours of
 ECMO withdrawal after IMPELLA® placement will be compared to patients without right
 heart failure on demographic, clinical, history, treatment history, and cardiac echo and
 hemodynamic data at admission.
Inclusion Criteria:

 1. - Patient over 18 years of age

 2. - Patient under ECMO hospitalized in the medical intensive care unit or the surgical
 intensive care unit of the Groupement hospitalier Pitié-Salpêtrière, not weaned from
 ECMO, in whom it was decided at the multidisciplinary collegial meeting on
 assistance-transplantation to set up an IMPELLA before the implantation of left
 monoventricular assistance.

 3. - Patient who received informed information about the study and did not express
 opposition to participation in the research.

 Special Cases :

 o For patients who are unable to express their non-opposition, the investigator may
 request that of a relative of the patient.

 or For patients under guardianship, their non opposition must be obtained in the
 presence of the guardian.

 or For patients under guardianship, it is the legal guardian's non opposition that
 will be requested.

 The modalities of information and obtaining the non opposition will be reported in the
 patient's medical file.

 4. - Patient affiliated or entitled to a French social security system -

 Exclusion Criteria:

 1. - SAPS-II Score > 90 (Simplified Acute Physiology Score (SAPS-II) at Inclusion

 2. - Subject deprived of liberty by judicial decision

 3. - Pregnant or breastfeeding woman