Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: incidence, risk factors, and effect on outcomes.
OBJECTIVE
The aim of this study was to evaluate the incidence, risk factors, and effect on outcomes of right ventricular failure in a large population of patients implanted with continuous-flow left ventricular assist devices.


METHODS
Patients (n = 484) enrolled in the HeartMate II left ventricular assist device (Thoratec, Pleasanton, Calif) bridge-to-transplantation clinical trial were examined for the occurrence of right ventricular failure. Right ventricular failure was defined as requiring a right ventricular assist device, 14 or more days of inotropic support after implantation, and/or inotropic support starting more than 14 days after implantation. Demographics, along with clinical, laboratory, and hemodynamic data, were compared between patients with and without right ventricular failure, and risk factors were identified.


RESULTS
Overall, 30 (6%) patients receiving left ventricular assist devices required a right ventricular assist device, 35 (7%) required extended inotropes, and 33 (7%) required late inotropes. A significantly greater percentage of patients without right ventricular failure survived to transplantation, recovery, or ongoing device support at 180 days compared with patients with right ventricular failure (89% vs 71%, P < .001). Multivariate analysis revealed that a central venous pressure/pulmonary capillary wedge pressure ratio of greater than 0.63 (odds ratio, 2.3; 95% confidence interval, 1.2-4.3; P = .009), need for preoperative ventilator support (odds ratio, 5.5; 95% confidence interval, 2.3-13.2; P < .001), and blood urea nitrogen level of greater than 39 mg/dL (odds ratio, 2.1; 95% confidence interval, 1.1-4.1; P = .02) were independent predictors of right ventricular failure after left ventricular assist device implantation.


CONCLUSIONS
The incidence of right ventricular failure in patients with a HeartMate II ventricular assist device is comparable or less than that of patients with pulsatile-flow devices. Its occurrence is associated with worse outcomes than seen in patients without right ventricular failure. Patients at risk for right ventricular failure might benefit from preoperative optimization of right heart function or planned biventricular support.
Kormos
Robert L
RL
Heart, Lung & Esophageal Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. kormosrl@upmc.edu
Teuteberg
Jeffrey J
JJ
Pagani
Francis D
FD
Russell
Stuart D
SD
John
Ranjit
R
Miller
Leslie W
LW
Massey
Todd
T
Milano
Carmelo A
CA
Moazami
Nader
N
Sundareswaran
Kartik S
KS
Farrar
David J
DJ
D000328:Adult; D000368:Aged; D001806:Blood Urea Nitrogen; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002496:Central Venous Pressure; D016009:Chi-Square Distribution; D002986:Clinical Trials as Topic; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D016017:Odds Ratio; D011669:Pulmonary Wedge Pressure; D012121:Respiration, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D018497:Ventricular Dysfunction, Right / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy
D002316:Cardiotonic Agents