title: Preoperative predictors and outcomes of right ventricular assist device implantation after continuous-flow left ventricular assist device implantation.
abstract: OBJECTIVE
  The outcomes of ventricular assist device therapy remain limited by right ventricular failure. We sought to define the predictors and evaluate the outcomes of right ventricular failure requiring right ventricular assist device support after long-term continuous-flow left ventricular assist device implantation.
  
  
  METHODS
  Records of all continuous-flow left ventricular assist device recipients for the last 10 years were analyzed, including patients on preoperative intra-aortic balloon pump, extracorporeal membrane oxygenation, and short-term ventricular assist device support. Perioperative clinical, echocardiographic, hemodynamic, and laboratory data of continuous-flow left ventricular assist device recipients requiring right ventricular assist device support (right ventricular assist device group) were compared with the rest of the patient cohort (control group).
  
  
  RESULTS
  Between July 2003 and June 2013, 152 patients underwent continuous-flow left ventricular assist device implantation as a bridge to transplantation. The overall postoperative incidence of right ventricular assist device support was 23.02% (n = 35). Right ventricular assist device implantation did not significantly affect eventual transplantation (P = .784) or longer-term survival (P = .870). Preoperative right ventricular diameter (P < .001), tricuspid annular plane systolic excursion (P < .001), previous sternotomy (P = .002), preoperative short-term mechanical support (P = .005), left atrial diameter (P = .014), female gender (P = .020), age (P = .027), and preoperative bilirubin levels (P = .031) were univariate predictors of right ventricular assist device implantation. Multivariate analysis revealed lesser tricuspid annular plane systolic excursion (P = .013; odds ratio, 0.613; 95% confidence interval, 0.417-0.901) and smaller left atrial diameter (P = .007; odds ratio, 0.818; 95% confidence interval, 0.707-0.947) as independent predictors of right ventricular assist device implantation. Receiver operating characteristic curve of tricuspid annular plane systolic excursion yielded an area under the curve of 0.85 (95% confidence interval, 0.781-0.923), with cutoff tricuspid annular plane systolic excursion less than 12.5 mm having 84% sensitivity and 75% specificity.
  
  
  CONCLUSIONS
  Lesser tricuspid annular plane systolic excursion and smaller left atrial diameter are independent predictors of the need for right ventricular assist device support after continuous-flow left ventricular assist device implantation. Right ventricular assist device implantation does not adversely affect eventual transplantation or survival after continuous-flow left ventricular assist device implantation.
authors: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom. Electronic address: n.patil@rbht.nhs.uk.
authors: Nikhil Prakash
authors: NP
authors: Patil
authors: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors: Prashant N
authors: PN
authors: Mohite
authors: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors: Anton
authors: A
authors: Sabashnikov
authors: Department of Heart Failure and Transplant Medicine, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors: Dhruva
authors: D
authors: Dhar
authors: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors: Alexander
authors: A
authors: Weymann
authors: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors: Mohamed
authors: M
authors: Zeriouh
authors: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors: Rachel
authors: R
authors: Hards
authors: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors: Michael
authors: M
authors: Hedger
authors: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors: Fabio
authors: F
authors: De Robertis
authors: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors: Toufan
authors: T
authors: Bahrami
authors: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors: Mohamed
authors: M
authors: Amrani
authors: Department of Cardiology, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors: Shelley
authors: S
authors: Rahman-Haley
authors: Department of Heart Failure and Transplant Medicine, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors: Nicholas R
authors: NR
authors: Banner
authors: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors: Aron Frederik
authors: AF
authors: Popov
authors: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors: André Rüdiger
authors: AR
authors: Simon
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology*
keywords: bridge to transplant; left ventricular assist device; right ventricular assist device; right ventricular failure