Can Perioperative Right Ventricular Support Prevent Postoperative Right Heart Failure in Patients With Biventricular Dysfunction Undergoing Left Ventricular Assist Device Implantation?
OBJECTIVE
Depending on the pre-existing condition of the right ventricle (RV), left ventricular assist device (LVAD) implantation may have a detrimental effect on RV function, subsequently leading to right heart failure. This study details the authors' experience with perioperative mechanical RV support in patients with biventricular impairment but primarily scheduled for isolated LVAD implantation.


METHODS
Retrospective study.


METHODS
Two center study, university hospital.


METHODS
This study included LVAD recipients with preoperative biventricular impairment who received an additional right ventricular assist device (RVAD) after a failed weaning attempt from cardiopulmonary bypass due to acute RV failure.


METHODS
Outcomes of 25 patients who underwent LVAD and unplanned temporary RVAD implantation were analyzed.


RESULTS
All patients experienced significant preoperative RV impairment (tricuspid annular plane systolic excursion: 10.2±26.3 mm; right atrium pressure: 17.9±10.4 mmHg) and pulmonary hypertension (pulmonary artery pressure: 54.8±25.7 mmHg). In 15 patients, additional tricuspid valve annuloplasty was performed. Mean duration of temporary RVAD support was 11.1±7.2 days. In 23 patients (92%), the RVAD was removed successfully. None of the patients developed RV failure after RVAD removal. Hospital survival and the 1-year survival rate of the study group were 68% and 56%, respectively.


CONCLUSIONS
The results of perioperative RVAD support in LVAD recipients with biventricular dysfunction are encouraging. Temporary RVAD support allows an already compromised RV to become attuned to the hemodynamic conditions after LVAD implantation. This strategy provides patients with preoperative impaired RV function a high likelihood to permanently undergo LVAD support only.
Department for Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany. Electronic address: deschkaheinz@hotmail.com.
Heinz
H
Deschka
Department for Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany.
Alexander J
AJ
Holthaus
Department for Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany.
Jürgen R
JR
Sindermann
Department for Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany.
Henryk
H
Welp
Department for Plastic and Aesthetic Surgery, Fachklinik Hornheide, Münster, Germany.
Dominik
D
Schlarb
Department for Thoracic and Cardiovascular Surgery, J.-W. Goethe Universität, Frankfurt/Main, Germany.
Nadejda
N
Monsefi
Department for Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany.
Sven
S
Martens
Department for Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany.
Mirela
M
Scherer
D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000517:prevention & control*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology
circulatory support devices; left ventricular assist device; right heart failure; right ventricular assist device