Right ventricular failure after implantation of continuous flow left ventricular assist device: analysis of predictors and outcomes

Abstract

Postoperative right ventricular failure is a serious complication for up to 50% of patients following LVAD insertion. Predicting RV failure is an important factor for patients as planned BiVAD support has been shown to correlate with better outcomes compared to delayed BiVAD to LVAD conversion. This retrospective study examined prospectively collected data for 101 patients implanted with an LVAD between 2003 and 2013, aiming to establish preoperative predictive factors for RVF post-LVAD insertion, analyze outcomes, and validate existing RVF scoring systems. In our cohort, 63 patients (62.4%) developed RV failure and consequently demonstrated consistently poorer survival throughout the follow-up period (log-rank p = 0.01). Multivariable logistic regression identified two significant variables: cardiac index <2.2 preoperatively despite inotropic support (OR 4.6 [95%CI 1.8-11.8]; p = 0.001) and preoperative tricuspid regurgitation (OR 8.1 [95%CI 1.9-34]; p = 0.004). Patients who developed RV failure had more complicated postoperative courses including longer ICU stay (p < 0.001), higher incidence of transfusions (p = 0.03) and re-intubation (p = 0.001), longer ventilation duration (p < 0.001), and higher incidence of returning to theater (p = 0.0008). This study found that previous validation models had only moderate correlation with our population emphasizing the need for prospective validation of these scores in the current era of continuous flow devices.

Effect of iloprost inhalation on postoperative outcome in high-risk cardiac surgical patients: a prospective randomized-controlled multicentre trial (ILOCARD)

“…The primary outcome parameter considered was the duration of postoperative ventilation, which we considered as a surrogate parameter for the severity of critical illness in cardiac surgical patients and is prolonged by PH, RV failure, shock, and prolonged ECC times. [25][26][27]…”

“…Iloprost 116 13 [10][11][12][13][14][15][16][17] 124 11 [8][9][10][11][12][13][14][15] 124 14 [10][11][12][13][14][15][16][17] 123 13 [10][11][12][13][14][15][16] 120 13 [10][11][12][13][14][15][16][17] MPAP (mmHg) Placebo 106 28 [22][23][24][25][26][27][28][29][30][31][32][33][34]…”

“…Iloprost 110 29 [24][25][26][27][28][29][30][31][32][33][34][35][36][37] 119 26 [20][21][22][23][24][25][26][27][28][29][30][31][32] 121 27 [22][23][24][25][26][27][28][29][30][31][32] 121 30 [25][26][27][28][29][30][31][32][33][34] 114 30 [25][26][27][28]…”

Results of concomitant groin-free percutaneous temporary RVAD support using a centrifugal pump with a double-lumen jugular venous cannula in LVAD patients

“…Nevertheless, Kalogeropoulos et al evaluated the existing predictive tests through external validation, showing merely a modest performance across currently available scores, with an average discrimination value of about 0.60. Despite existing scores and growing experience, RHF still occurs in up to 50% of all LVAD cases (7)(8)(9).…”

Changes in left and right ventricular two-dimensional echocardiographic speckle-tracking indices in pediatric LVAD population: A retrospective clinical study

“…While the beneficial effects of left ventricular (LV) unloading provided by left ventricular assist device (LVAD) are well known, the LVAD effects on right ventricular (RV) function are controversial and RV failure has been addressed as an independent risk factor for adverse outcome in LVAD recipients. 1–3…”