Preoperative and perioperative predictors of right ventricular failure after left ventricular assist device implantation
Makaleler > Tam Makale · 2022
Yazarlar: Gokhan Avci, Sanem NALBANTGİL, Hatice Kemal, Serkan ERTUGAY, Çağatay ENGİN, Tahir YAĞDI, Mustafa Ozabaran
International Journal of the Cardiovascular Academy, Uluslararası, Scopus, 2022, cilt 8, ss 53-53
Özet
IntroductIonRight ventricular failure (RVF) is an important cause of the morbidity and mortality that develops in patients with left ventricular assist devices (LVADs).RVF prolongs stay in the intensive care unit, increases 30-day mortality, and decreases the transplantation bridging rates.[1,2] INTERMACS has defined RVF as a condition leading to low cardiac output, high central venous pressure (CVP), low left ventricle filling pressure, and requires inotrope infusions for longer than 14 days or ECMO or right ventricular assist devices (RVAD).[3] The incidence of RVF after LVAD implantation varies from 6 to 44% according to recent studies.This large variability is due to differences in definitions of RVF and the patient populations of the studies.[4] Some authors defined RVF only as a condition of need RVAD, [5][6][7] and some others especially INTERMACS defined RVF as a condition leading to low cardiac output, high CVP, low left ventricle filling pressure, Background: Right ventricular (RV) failure is a serious adverse event for patients with left ventricular assist devices (LVADs).Here, we seek to identify the risk factors which may predict the development of RV failure (RVF).Methods and Results: Forty-two patients were implanted with LVADs (32 HeartWare ® ventricular assist device and 10 Thoratec ® HeartMate II) between March 2013 and April 2014 at the Ege University Medical School, Izmir, Turkey.Baseline clinical, demographic, and laboratory information were measured and patients prospectively fallowed after surgery.Endpoint was defined RVF development for patients.Before surgery, hemodynamic parameters, electrocardiographic findings, standard echocardiographic measurements, and medications were recorded.Multivariate regression analysis showed that the presence of ascites, prealbumin <14 mg/dl, bilirubin >1.5 mg/dl, RV diameter >3.2 cm, RV-fractional area change (FAC) <24%, right atrial area (RAA) >28 cm, 2 and RV-myocardial performance index >0.35were the strongest predictors of RVF after LVAD implantation.Conclusions: RAA and RV-FAC are easily obtained and should be evaluated in potential LVAD patients.Risk assessment systems should also take into account the presence of ascites and low prealbumin levels which are not currently incorporated into any risk models.Validation of the relative importance of all of these parameters requires further investigation.