title: Late-onset right ventricular dysfunction after mechanical support by a continuous-flow left ventricular assist device.
abstract: BACKGROUND
  Right heart failure (RHF) is a serious post-operative complication of left ventricular assist device (LVAD) implantation, with significant morbidity and mortality. Many clinical, hemodynamic and laboratory variables have been shown to have prognostic value for appearance of RHF. We sought to investigate the incidence of new-onset right ventricular dysfunction (RVD) complicating the long-term use of LVADs.
  
  
  METHODS
  We retrospectively examined all patients supported with a continuous-flow LVAD for >1 year at our center.
  
  
  RESULTS
  Twenty patients (mean age 54 ± 10 years, 95% men, 60% with ischemic cardiomyopathy, left ventricular ejection fraction 22 ± 6%, pulmonary capillary wedge pressure 23.5 ± 7.5 mm Hg, brain natriuretic peptide [BNP] 1,566 ± 1,536 pg/ml, serum creatinine 1.6 ± 0.64 mg/dl, furosemide dose 643 ± 410 mg/day) underwent long-term mechanical support as destination therapy support with a continuous-flow LVAD (HeartMate II) at our center. During follow-up (1,219 ± 692 days), 9 patients (45%) manifested symptoms and signs of RVD (increase in right atrial pressure [RAP], BNP and daily furosemide dose compared with the early post-operative period). In these patients, RAP was increased by 6.6 ± 2.6 mm Hg and BNP by 526 ± 477 pg/ml, whereas furosemide dose increased by 145 ± 119 mg. The mean and median times of RVD onset were 2.3 ± 1.5 and 2.1 years, respectively, after LVAD implantation (range 0.4 to 4.8 years). Four of these patients (44.4%) demonstrated further deterioration of RV function and died 73 ± 106 days (median 25 days, range 9 to 231 days) after first manifestation of RVD. Comparisons of baseline variables regarding medical history and clinical status did not demonstrate significant differences between the patients with or without RVD, including parameters related to RV function at the time of implantation.
  
  
  CONCLUSIONS
  Late-onset RVD is a complication of LVAD support, which can manifest several months to years from device implantation. This complication has significant adverse implications with regard to patient outcome. Prognostic factors need to be identified to follow and treat high-risk patients more efficiently.
authors.affiliation: Department of Cardiology, University of Athens School of Medicine, Athens.
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Kapelios
authors.affiliation: Department of Cardiac Surgery, Evangelismos Hospital, Athens.
authors.forename: Christos
authors.initials: C
authors.lastname: Charitos
authors.affiliation: Department of Cardiology, University of Athens School of Medicine, Athens.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Kaldara
authors.affiliation: Department of Cardiology, University of Athens School of Medicine, Athens.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Malliaras
authors.affiliation: Department of Cardiology, University of Athens School of Medicine, Athens.
authors.forename: Emmeleia
authors.initials: E
authors.lastname: Nana
authors.affiliation: Department of Cardiology, University of Athens School of Medicine, Athens.
authors.forename: Christos
authors.initials: C
authors.lastname: Pantsios
authors.affiliation: Department of Cardiology, University of Athens School of Medicine, Athens.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Repasos
authors.affiliation: Department of Cardiac Surgery, Evangelismos Hospital, Athens.
authors.forename: Michael
authors.initials: M
authors.lastname: Tsamatsoulis
authors.affiliation: Department of Therapeutics, Alexandra Hospital, University of Athens Medical School, Athens, Greece.
authors.forename: Savvas
authors.initials: S
authors.lastname: Toumanidis
authors.affiliation: Department of Cardiology, University of Athens School of Medicine, Athens. Electronic address: inanas@med.uoa.gr.
authors.forename: John N
authors.initials: JN
authors.lastname: Nanas
mesh_terms: D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D013997:Time Factors; D018497:Ventricular Dysfunction, Right / Q000453:epidemiology / Q000209:etiology*
keywords: chronic heart failure; destination therapy; left ventricular assist device; mechanical support; right ventricular dysfunction; right ventricular failure