Right ventricular dysfunction and organ failure in left ventricular assist device recipients: a continuing problem.
BACKGROUND
Although right ventricular assist device (RVAD) use has declined with the introduction of inhaled nitric oxide and phosphodiesterase inhibitors (type III), right ventricular dysfunction (RVD) is still a serious problem in patients receiving left ventricular assist devices (LVAD).


METHODS
We retrospectively analyzed Thoratec Vented Electrical LVAD recipients between June 1996 and September 1999. RVD was defined as inotropic requirement 14 days or more or need for RVAD postoperatively, or both.


RESULTS
Sixty-nine LVAD recipients were analyzed. Twenty-one patients (30.4%) had RVD, with 1 patient requiring RVAD insertion, and there were 48 non-RVD patients. There were no significant differences between both groups for age, sex, etiology of congestive heart failure, days of support, and preoperative hemodynamics. Preoperative right ventricle stroke work index (mm Hg x m(-2) x L(-1)) had a trend toward being lower in the RVD group (4.1+/-3.2 versus 6.1+/-3.7, p = 0.06). A higher preoperative total bilirubin (mg/dL) was noticed in the RVD group (4.0+/-5.2 versus 2.1+/-1.7). The RVD group had a higher postoperative creatinine (2.2+/-1.4 mg/dL versus 1.5+/-0.8 mg/dL), incidence of continuous venovenous hemofiltration dialysis (73% versus 26%), transfusion of packed red blood cells (43.2+/-28.6 units versus 24.7+/-18.9 units), platelets (58.6+/-46.1 units versus 30.2+/-20.4 units), with longer intensive care unit length of stay (33.6+/-34.7 days versus 9.1+/-6.9) and higher mortality (42.8% versus 14.5%). When deaths were excluded, both intensive care unit and postoperative length of stay were significantly longer in the RVD group.


CONCLUSIONS
RVD in LVAD recipients remains poorly identified and is associated with a high transfusion rate and end organ failure that results in increased intensive care unit and hospital length of stay, and a high mortality rate. Preoperative identification of risk factors for RVD may select patients who would benefit from a biventricular assist device and prevent the subsequent end organ failure.
Kavarana
Minoo N
MN
Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
Pessin-Minsley
Melissa S
MS
Urtecho
Jacqueline
J
Catanese
Katharine A
KA
Flannery
Margaret
M
Oz
Mehmet C
MC
Naka
Yoshifumi
Y
D000368:Aged; D001803:Blood Transfusion; D009202:Cardiomyopathies / Q000601:surgery; D001026:Coronary Artery Bypass; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006439:Hemodynamics; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000601:surgery; D012189:Retrospective Studies; D018497:Ventricular Dysfunction, Right / Q000209:etiology* / Q000401:mortality