Preoperative risk factors for right ventricular failure after implantable left ventricular assist device insertion.
BACKGROUND
Implantable left ventricular assist device (LVAD) insertion complicated by early right ventricular (RV) failure has a poor prognosis and is generally unpredictable.


METHODS
To determine preoperative risk factors for perioperative RV failure after LVAD insertion, patient characteristics and preoperative hemodynamics were analyzed in 100 patients with the HeartMate LVAD (Thermo Cardiosystems, Inc, Woburn, MA) at the Cleveland Clinic.


RESULTS
RV assist device support was required for 11 patients (RVAD group). RVAD use was significantly higher in younger patients, female patients, smaller patients, and myocarditis patients. There was no significant difference in the cardiac index, RV ejection fraction, or right atrial pressure between the two groups preoperatively. The preoperative mean pulmonary arterial pressure (PAP) and RV stroke work index (RV SWI) were significantly lower in the RVAD group (p = 0.015 and p = 0.011, respectively). Survival to transplant was poor in the RVAD group (27%) and was 83% in the no-RVAD group.


CONCLUSIONS
The need for perioperative RVAD support was low, only 11%. Preoperative low PAP and low RV SWI were significant risk factors for RVAD use.
Fukamachi
K
K
Department of Biomedical Engineering, The Kaufman Center for Heart Failure, The Cleveland Clinic Foundation, Ohio 44195, USA. fukamach@bme.ri.ccf.org
McCarthy
P M
PM
Smedira
N G
NG
Vargo
R L
RL
Starling
R C
RC
Young
J B
JB
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011651:Pulmonary Artery; D012307:Risk Factors; D013318:Stroke Volume; D018497:Ventricular Dysfunction, Right / Q000209:etiology* / Q000503:physiopathology