Right ventricular dysfunction following continuous flow left ventricular assist device placement in 51 patients: predicators and outcomes.
BACKGROUND
Right ventricular (RV) dysfunction following implantation of a left ventricular assist device (LVAD) is a serious condition and is associated with increased mortality.


METHODS
The aim of the study is to investigate the significance of pre-existing RV dysfunction, tricuspid valve (TV) insufficiency, and the severity of septal deviation following LVAD implantation on RV dysfunction, as well as the outcome and short-term complications in 51 patients from June 2006 to August 2010. Student t test was used to compare the data and estimate the p value.


RESULTS
Mean age was 55.1 ± 13, with a male to female ratio of 3.25. The 30-day mortality was 13.7% (7/51 patients), and the overall mortality was 23.5% (12/51 patients). Meanwhile, 21 patients (21/51; 41.2%) have undergone orthotopic heart transplantation. The mean time of support was 314.5±235 days with a median of 240 days at the time of closing this study. Echocardiographic evaluation of RV function pre- and post-implantation of an LVAD demonstrated septal deviation towards the left ventricle in immediate postoperative phase, which correlated with acute RV dysfunction (p = 0.002). Preoperative RV dysfunction was a significant predictor of postoperative right heart dysfunction following implantation of an LVAD (p = 0.001).


CONCLUSIONS
Preoperative RV dysfunction is a predictor of RV failure in LVAD patients. The adjustment of septal deviation through gradual increase of the LVAD flow can prevent the acute RV dysfunction following LVAD placement.
Department of Cardiothoracic Surgery, Albert Einstein College of Medicine, New York, NY 10467, USA. sneragi@yahoo.com
Siyamek
S
Neragi-Miandoab
Daniel
D
Goldstein
Ricardo
R
Bello
Robert
R
Michler
David
D
D'Alessandro
D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D009202:Cardiomyopathies / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery; D006346:Heart Septum / Q000503:physiopathology / Q000601:surgery; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000503:physiopathology / Q000601:surgery; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology / Q000601:surgery*