title: Predicting right ventricular failure in the modern, continuous flow left ventricular assist device era.
abstract: BACKGROUND
  In the era of destination continuous flow left ventricular assist devices (LVAD), the decision of whether a patient will tolerate isolated LVAD support or will need biventricular support (BIVAD) can be challenging. Incorrect decision making with delayed right ventricular (RV) assist device implantation results in increased morbidity and mortality. Continuous flow LVADs have been shown to decrease pulmonary hypertension and improve RV function. We undertook this study to determine predictors in the continuous flow LVAD era that identify patients who are candidates for isolated LVAD therapy as opposed to biventricular support.
  
  
  METHODS
  We reviewed demographic, hemodynamic, laboratory, and echocardiographic variables for 218 patients who underwent VAD implant from 2003 through 2011 (LVAD=167, BIVAD=51), during the era of continuous flow LVADs.
  
  
  RESULTS
  Fifty preoperative risk factors were compared between patients who were successfully managed with an LVAD and those who required a BIVAD. Seventeen variables demonstrated statistical significance by univariate analysis. Multivariable logistic regression analysis identified central venous pressure>15 mmHg (OR 2.0, "C"), severe RV dysfunction (OR 3.7, "R"), preoperative intubation (OR 4.3, "I"), severe tricuspid regurgitation (OR 4.1, "T"), heart rate>100 (OR 2.0, Tachycardia-"T")-CRITT as the major criteria predictive of the need for biventricular support. Utilizing these data, a highly sensitive and easy to use risk score for determining RV failure was generated that outperformed other established risk stratification tools.
  
  
  CONCLUSIONS
  We present a preoperative risk calculator to determine suitability of a patient for isolated LVAD support in the current continuous flow ventricular assist device era.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Pavan
authors.initials: P
authors.lastname: Atluri
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Goldstone
authors.forename: Alex S
authors.initials: AS
authors.lastname: Fairman
authors.forename: John W
authors.initials: JW
authors.lastname: MacArthur
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Shudo
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Cohen
authors.forename: Alexandra L
authors.initials: AL
authors.lastname: Acker
authors.forename: William
authors.initials: W
authors.lastname: Hiesinger
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Howard
authors.forename: Michael A
authors.initials: MA
authors.lastname: Acker
authors.forename: Y Joseph
authors.initials: YJ
authors.lastname: Woo
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000601:surgery; D006353:Heart-Assist Devices; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*
keywords: 27