Assessment of Preoperative Echocardiographic Parameters as Predictors of Early Right Ventricular Failure in the Current Era of Continuous-Flow Left Ventricular Assist Devices

Background The development of right ventricular failure (RVF) is common following continuous-flow left ventricular assist device (CF-LVAD) implantation, occurring in 13%-40% of patients. With the LVAD and right heart operating in series, LVAD function relies heavily on RV function for adequate preload. Severe RVF can lead to systemic hypoperfusion, multi-organ failure, prolonged hospitalization, poor quality of life, and death. Hypothesis Identifying patients at risk of developing severe RVF post-implantation may assist the care team in taking the necessary precautions to potentially avoid RVF or to be aggressive in its management. Methods This was a single-center review of CF-LVAD implantations from 2014 to 2016. Excluded were INTERMACS1 patients, redo LVADs, preoperative advanced RVF, refractory pulmonary vascular resistance u003e6 WU, and prosthetic mitral or tricuspid valve. RVF was defined as requiring RVAD or inhaled nitric oxide or other pulmonary vasodilator post-op for ≥48h or inotropic therapy for ≥7d any time post-op. Assessment of pre-implant RV function was based on an extensive set of echocardiographic parameters ( Tables 1 u0026 2 ). Results Of 55 patients (95% were HeartMate II), a total of 46 (84%) developed significant RVF. Those with and without RVF did not differ in gender or age. RV stroke volume (P=0.04), RV stroke volume index (P=0.04), and mitral valve regurgitation jet area (P=0.05) were significantly lower in patients with RVF ( Table 1 ). Conclusion RV cardiac output is calculated as RV stroke volume x heart rate. Thus, early RVF post-LVAD may be explained by low RV stroke volume. In standard practice, however, RV stroke volume and RV stroke volume index are not routinely calculated from the pre-implant echocardiogram. This study, despite its small sample size, suggests potential prognostic value for these echo parameters for the evaluation of RVF. Larger studies are needed to validate these results.