Right ventricular failure following left ventricular assist device implantation is associated with a preoperative pro-inflammatory response

Abstract

Background Systemic inflammation during implant of a durable left ventricular assist device (LVAD) may contribute to adverse outcomes. We investigated the association of the preoperative inflammatory markers with subsequent right ventricular failure (RVF). Materials and methods Prospective data was collected on 489 patients from 2003 through 2017 who underwent implantation of a durable LVAD. Uni- and multivariable correlation with leukocytosis was determined using linear and binary logistic regression. The population was also separated into low (< 10.5 K/ul, n = 362) and high ( > 10.5 K/ul, n = 127) white blood cell count (WBC) groups. Mantel-Cox statistics was used to analyze survival data. Results Postop RVF was associated with a higher preop WBC (11.3 + 5.7 vs 8.7 + 3.1) and C-reactive protein (CRP, 5.6 + 4.4 vs 3.3 + 4.7) levels. Multivariable analysis identified an independent association between increased WBC preoperatively with increased lactate dehydrogenase (LDH, P < 0.001), heart rate ( P < 0.001), CRP ( P = 0.006), creatinine ( P = 0.048), and INR ( P = 0.049). The high WBC group was more likely to be on preoperative temporary circulatory support (17.3% vs 6.4%, P < 0.001) with a trend towards greater use of an intra-aortic balloon pump (55.9% vs 47.2%, P = 0.093). The high WBC group had poorer mid-term survival ( P = 0.042). Conclusions Postop RVF is associated with a preoperative pro-inflammatory environment. This may be secondary to the increased systemic stress of decompensated heart failure. Systemic inflammation in the decompensated heart failure may contribute to RVF after LVAD implant.

Cardiovascular Implantable Electronic Device Infection and New Insights About Correlation Between Pro-inflammatory Markers and Heart Failure: A Systematic Literature Review and Meta-Analysis

“…We analyzed the percentage distribution of comorbidities using 18 of 22 studies because of the absence of comorbidity data in 4 studies ( 20 , 22 , 35 , 41 ). All studies outlined a high heterogeneity in the type and rate of diseases.…”

“…CIED complete removal and antimicrobial therapy was the prevalent treatment, so we obtained its prevalence using the forest plot ( Figure 6A ). We selected 16 of 22 studies because of the absences of data about post-operative treatment in the other 6 studies ( 18 , 20 , 22 , 23 , 35 , 41 ). We used 6 of 16 studies because all patients received CIED complete removal and antimicrobial therapy in the other 10 studies ( 25 , 27 – 29 , 33 , 34 , 37 – 40 ).…”

“…We analyzed causes of death percentage distribution in 13 of 22 studies ( Figure 7A ) due to the absence of data on the causes of death in 7 studies ( 20 – 23 , 25 , 33 , 35 , 37 , 41 ). Sepsis was the most prevalent cause of death.…”

Fate of preoperative moderate mitral regurgitation following left ventricular assist device implantation

“…Despite a generous reduction in LV size by mechanical unloading, more than 30% of LVAD recipients with preoperative significant MR continued to have significant MR after surgery 4 . Significant residual MR may increase pulmonary vascular resistance, reduce right ventricular function, increase the risk of clinical right ventricular failure, increase hospital readmissions after LVAD, and potentially negatively impact survival in select settings such as destination therapy 13‐15 . While many prior studies have examined a combined moderate and severe preoperative MR group for evaluation of post‐LVAD MR resolution and outcomes, 2‐4 there may be distinct outcomes for preoperative moderate MR after LVAD.…”

Risk of Thrombus Formation in Patients on Mechanical Circulatory Support with POLVAD-MEV

“…The overall results of LVAD patients are related to preoperative and postoperative inflammatory triggers. Inflammatory reactions in patients on mechanical support can cause right ventricle failure, which complicates up to 40% of implantations [ 23 ]. Midterm mortality rates are also affected by preoperative increased inflammatory parameters [ 24 ].…”