Risk score derived from pre-operative data analysis predicts the need for biventricular mechanical circulatory support.
BACKGROUND
Right ventricular (RV) failure after left ventricular assist device (LVAD) placement is a serious complication and is difficult to predict. In the era of destination therapy and the total artificial heart, predicting post-LVAD RV failure requiring mechanical support is extremely important.


METHODS
We reviewed patient characteristics, laboratory values and hemodynamic data from 266 patients who underwent LVAD placement at the University of Pennsylvania from April 1995 to June 2007.


RESULTS
Of 266 LVAD recipients, 99 required RV assist device (BiVAD) placement (37%). We compared 36 parameters between LVAD (n = 167) and BiVAD patients (n = 99) to determine pre-operative risk factors for RV assist device (RVAD) need. By univariate analysis, 23 variables showed statistically significant differences between the two groups (p < or = 0.05). By multivariate logistic regression, cardiac index < or =2.2 liters/min/m(2) (odds ratio [OR] 5.7), RV stroke work index < or =0.25 mm Hg . liter/m(2) (OR 5.1), severe pre-operative RV dysfunction (OR 5.0), pre-operative creatinine > or =1.9 mg/dl (OR 4.8), previous cardiac surgery (OR 4.5) and systolic blood pressure < or =96 mm Hg (OR 2.9) were the best predictors of RVAD need.


CONCLUSIONS
The most significant predictors for RVAD need were cardiac index, RV stroke work index, severe pre-operative RV dysfunction, creatinine, previous cardiac surgery and systolic blood pressure. Using these data, we constructed an algorithm that can predict which LVAD patients will require RVAD with >80% sensitivity and specificity.
Fitzpatrick
J Raymond
JR
Division of Cardiovascular Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Frederick
John R
JR
Hsu
Vivian M
VM
Kozin
Elliott D
ED
O'Hara
Mary Lou
ML
Howell
Elan
E
Dougherty
Deborah
D
McCormick
Ryan C
RC
Laporte
Carine A
CA
Cohen
Jeffrey E
JE
Southerland
Kevin W
KW
Howard
Jessica L
JL
Jessup
Mariell L
ML
Morris
Rohinton J
RJ
Acker
Michael A
MA
Woo
Y Joseph
YJ
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D048909:Diabetes Complications / Q000453:epidemiology; D004867:Equipment Design; D005260:Female; D006333:Heart Failure / Q000503:physiopathology* / Q000601:surgery; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology / Q000601:surgery*; D016278:Ventricular Function, Right