Risk factors of early right ventricular failure in patients undergoing LVAD implantation with intermediate Intermacs profile for advanced heart failure

Abstract

Background The clinical profile of left ventricular assist device (LVAD) candidates is rapidly changing, with increasing proportion of patients in more stable clinical conditions. However, early postoperative right ventricular failure (eRVF) is still one of the cornerstones associated with increased mortality and the preoperative recognition of associated risk factors remains challenging. The aim of this study was to identify predictive parameters for eRVF after LVAD implantation in patients with preoperative intermediate Intermacs (InM) risk profile 3‐5. Methods Preoperative laboratory, echocardiography, and right heart catheterization data collected from 80 patients with InM profile 3‐5 before LVAD implantation were retrospectively tested with respect to their ability to predict the risk for eRVF after the implantation of a continuous‐flow LVAD. Results Preoperative higher bilirubin and blood urea nitrogen (BUN) levels, higher Model for End‐stage Liver Disease score, lower estimated glomerular filtration rate, and higher central venous pressure to pulmonary capillary wedge pressure ratio (CVP/PCWP) were associated to higher risk of eRVF. Regarding the echocardiographic assessment, higher end diastolic linear dimensions of the RV, higher basal end diastolic RV linear dimension to LV ratio, severe tricuspid regurgitation, lower tricuspid annular plane systolic excursion, and lower RV fractional area contraction identified patients with higher risk for eRVF. In the multivariable analysis, a CVP/CPWP > 0.55 (odds ratio [OR]: 4, 95% confidence interval [CII]: 1.4‐11.8;P = .01) and BUN > 44.5 mg/dL (OR: 6.6, 95% CI: 1.51‐23; P = .011) independently predicted the risk of eRVF. Conclusion Preoperative BUN > 44.5 mg/dL and CVP/PCWP > 0.55 are associated to an increased risk of eRVF following LVAD implantation in intermediate InM patients.

Assessment of right ventricular function following left ventricular assist device (LVAD) implantation—The role of speckle‐tracking echocardiography: A meta‐analysis

“…Seventeen studies, with a total number of 1085 LVAD recipients, fulfilled our inclusion criteria 8,13,18‐32 . Study characteristics and outcomes are summarized in Tables 1 and 2.…”

“…RVGLS was reported in 11 studies (9 TTE and 2 TEE studies). 8,[20][21][22][23][27][28][29][31][32][33] The RVGLS was significantly reduced preoperatively in the RVF group as compared to non-RVF group when analyzed for the whole cohort (TEE and TTE). The SMD between the RVF and the non-RVF groups was −2.79 (95% CI: −4.07 to −1.50; P-value < .001), I 2 = 91.31%.…”

“…Seventeen studies, with a total number of 1085 LVAD recipients, fulfilled our inclusion criteria. 8,13,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] Study characteristics and outcomes are summarized in Tables 1 and 2. Thirteen studies used transthoracic echocardiography (TTE) strain, while four studies utilized transesophageal echocardiography (TEE).…”

Continuous-flow left ventricular assist device: Current knowledge, complications, and future directions

“…All patients must have complete imaging and hemodynamic assessment. Regarding echocardiographic parameters, longitudinal excursion of the right ventricle free wall and more than moderate RV dysfunction were the most frequent parameters associated with RV failure [ 3 , 58 , 59 ]. When talking about hemodynamics, central venous pressure and right ventricle working systolic index appear to be the predictors of RV failure [ 53 , 60 , 61 ].…”

Six‐month outcomes in postapproval HeartMate3 patients: A single‐center US experience

“…This finding can be explained by our incremental improvement in understanding the HM3 device, improved perioperative management, and a significant reduction in the incidence of postoperative bleeding requiring re-exploration (a well-established risk factor for the development of RVF). [17][18][19][20][21][22][23] Also, the incidence of right ventricular assist device (RVAD) use for severe RVF was similar between the two groups.…”