Right ventricular failure after left ventricular assist device insertion: preoperative risk factors

Abstract

Right ventricular failure after left ventricular assist device placement is the major concern on weaning from cardiopulmonary bypass and it is one of the most serious complications in the postoperative period. This complication has a poor prognosis and is generally unpredictable. The identification of pre-operative risk factor for this serious complication is incomplete yet. In order to determine pre-operative risk for severe right ventricular failure after left ventricular assist device support we analyzed preoperative hemodynamics, laboratory data and characteristics of 48 patients who received Novacor (World Heart Corp., Ottawa, ON, Canada). We compared the data from the patients who developed right ventricular failure and the patients who did not. Right ventricular failure occurred in 16% of the patients. There was no significant difference between the groups in demographic characteristics. We identified as preoperative risk factors the pre-operative low mean pulmonary artery and the impairment of hepatic and renal function on laboratory data. Our results confirm in part the findings of the few previous studies. This information may be useful for the patient selection for isolated left ventricular assist device implantation, but other studies are necessary before establishing criteria for patient selection for univentricular support universally accepted.

Load Dependency of Right Ventricular Performance Is a Major Factor to be Considered in Decision Making Before Ventricular Assist Device Implantation

“…Some investigating groups did not find, for example, elevated serum bilirubin levels to be a relevant risk factor for postoperative RV failure in their patients. 9,18 Quantitative scoring systems for predicting the need for an additional RV support in patients with congestive HF also include one or the other above-mentioned risk factors, such as CI, serum creatinine, blood urea nitrogen, or serum bilirubin. 1,16,17 In our previous study, patients with RV failure after LVAD implantation had preoperatively higher S/L ED ratios reflecting higher TV geometry alterations, lower CI, more pronounced TR, higher CVP values, and also higher NT-ProBNP and C-reactive protein values.…”

“…1,9-15 Thus, previous important studies on this topic showed that patients with severe RV failure after LVAD implantation usually have a lower preoperative CI, more elevated CVP, lower tricuspid annulus peak systolic excursion, higher bilirubin, higher aspartate and alanine aminotransferase, higher blood urea nitrogen, and higher serum creatinine levels. 1,3,[14][15][16][17][18][19] However, not all of these variables appeared in all studies as relevant risk factors that might be at least partially explained by differences between different centers with regard to their selection criteria for LVAD and BVAD implantation. Some investigating groups did not find, for example, elevated serum bilirubin levels to be a relevant risk factor for postoperative RV failure in their patients.…”

Combination Evaluation of Preoperative Risk Indices Predicts Requirement of Biventricular Assist Device

“…These indices need an invasive measurement of hemodynamics in severely ill patients, and instead some investigators claim that combinations of preoperative parameters, which are able to be non-invasively obtained, well predict postoperative RV failure. 11- 15 We maintain, however, that preoperative risk stratification for the necessity of BiVAD remains to be elucidated, and that there have been very few reports from Japan. 16 The aim of this study was to identify preoperative risk factors for the requirement of BiVAD therapy and to create a novel scoring system (Todai RV failure score: TRV score) for predicting BiVAD therapy.…”

Recovery of right heart function with temporary right ventricular assist using a centrifugal pump in patients with severe biventricular failure

“…[3][4][5][6][7]12 Several researchers have reported a significantly lower rate of a successful bridge to transplantation in BiVAD patients (25%-58%) than in isolated LVAD patients (74%-100%). [5][6][7]12 In Japan, where the average wait for a heart transplant exceeds 2 years and the successful bridge-to-transplant rate of BiVAD patients is extremely low, avoiding BiVAD placement should be considered for as long as possible. We are facing a dilemma: mechanical right heart support should be established without a delay in a patient with severe RV failure after LVAD implantation, and at the same time, long-term BiVAD support should be avoided as far as possible.…”