Original Articles: CardiovascularPreoperative risk factors for right ventricular failure after implantable left ventricular assist device insertion
Section snippets
Device
The implantable TCI HeartMate LVAD (Thermo Cardiosystems, Inc) used in this study was either the pneumatic air-driven system (1000 IP) or the vented-electric system (V-E). The pump uses a pusher-plate mechanism with a maximum stroke of 85 mL and a maximum pump output of approximately 11 L/min. Patient selection criteria, description of the device, implantation technique, management, and indications for transplantation were published previously 1, 3.
Patients
From December 1991 to December 1996, HeartMate
Results
Table 1summarizes the patients’ preoperative characteristics and laboratory data in each group. RVAD use was significantly higher in female patients, younger patients, and smaller patients. All 3 patients diagnosed with myocarditis fell into the RVAD group. The need for a preoperative intraaortic balloon pump (IABP), ventilator, or extracorporeal membrane oxygenation (ECMO) support were not risk factors for RVAD use. Only 10 patients did not require any mechanical or ventilatory support
Comment
Pulmonary hypertension with elevated PVR has been considered to be a contraindication for LVAD use because of the high risk for RV failure after LVAD insertion [3]. Our study, however, indicated that a preoperative low PAP was a significant risk factor for RVAD use. Although the mean PAP was greater than 40 mm Hg in 36% of the patients in the no-RVAD group, none of the patients in the RVAD group had a mean PAP greater than 40 mm Hg. This finding suggests that RV contractility was not strong
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