Defining early right ventricular failure during left ventricular assist device implantation: Retrospective analysis of intraoperative management

Abstract

Objectives: In this study, we aimed to share the intraoperative anesthesia management of left ventricular assist device (LVAD) implantation and our approach to right ventricular failure (RVF) that developed in this process, and our results. Patients and methods: A total of 82 patients (71 males, 11 females; mean age: 49.4±9.4 years; range, 18 to 71 years) who underwent LVAD implantation between February 2013 and June 2020 were included in the retrospective study. Preoperative echocardiography, cardiac catheterization findings, and intraoperative records were reviewed. In light of the preoperative hemodynamic, echocardiographic, and preoperative echocardiographic findings of the patients, RVF levels were preoperatively determined, and a medical and mechanical support therapy algorithm for RVF was created. The postoperative outcomes were evaluated within the framework of this algorithm. Results: The mean preoperative left ventricular ejection fraction was 19.6%, and the mean right ventricular ejection fraction was 37.4%. According to our algorithm, eight (9.7%) patients developed severe, 12 (14.6%) moderate, and 48 (58.5%) mild RVF. No RVF was present in 14 (17.2%) patients. The vasoactive inotrope score was 25.7±1.3 in the advanced RVF group and compatible with the severity of RVF. Extracorporeal membrane oxygenation use was required in three (37.5%) patients who had severe RVF. Right ventricular assist device was implanted in one of the three patients with extracorporeal membrane oxygenation due to advanced RVF in the postoperative period. Mortality was observed in two (25%) patients in the advanced group, one (8.3%) in the moderate, three (6.25%) in the mild, and two (14%) in the normal RVF group. Conclusion: A standardized method for defining the RVF severity and a well-defined treatment protocol according to its degree of severity is lacking. Considering hemodynamic and echocardiographic data, grading of RVF in patients is vital for determining the treatment protocol. Treatment for RVF should be converted into standard universal algorithms.