Elsevier

The Annals of Thoracic Surgery

Volume 68, Issue 6, December 1999, Pages 2181-2184
The Annals of Thoracic Surgery

Original Articles: Cardiovascular
Preoperative risk factors for right ventricular failure after implantable left ventricular assist device insertion

https://doi.org/10.1016/S0003-4975(99)00753-5Get rights and content

Abstract

Background. Implantable left ventricular assist device (LVAD) insertion complicated by early right ventricular (RV) failure has a poor prognosis and is generally unpredictable.

Methods. To determine preoperative risk factors for perioperative RV failure after LVAD insertion, patient characteristics and preoperative hemodynamics were analyzed in 100 patients with the HeartMate LVAD (Thermo Cardiosystems, Inc, Woburn, MA) at the Cleveland Clinic.

Results. RV assist device support was required for 11 patients (RVAD group). RVAD use was significantly higher in younger patients, female patients, smaller patients, and myocarditis patients. There was no significant difference in the cardiac index, RV ejection fraction, or right atrial pressure between the two groups preoperatively. The preoperative mean pulmonary arterial pressure (PAP) and RV stroke work index (RV SWI) were significantly lower in the RVAD group (p = 0.015 and p = 0.011, respectively). Survival to transplant was poor in the RVAD group (27%) and was 83% in the no-RVAD group.

Conclusions. The need for perioperative RVAD support was low, only 11%. Preoperative low PAP and low RV SWI were significant risk factors for RVAD use.

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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  • Impact of right ventricular stroke work index on predicting hospital readmission and functional status of patients with advanced heart failure

    2020, Revista Portuguesa de Cardiologia
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    RVSWI is an invasive hemodynamic parameter and data on its clinical use are lacking. Previous reports on RVSWI were mostly concerned with left ventricular assist device insertion,18 in which it was demonstrated to be a preoperative risk factor for RV failure after device insertion, or after lung transplantation, for which it was a predictor of mortality and length of hospital stay.19 In our study, we analyzed RVSWI as a marker for RV systolic function to predict acute decompensation of chronic HF.

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