Echocardiographic Parameters to Predict Right Heart Failure after LVAD Implantation Requiring Mechanical Right Ventricular Support

Objectives: Left ventricular assist device (LVAD) implantation is a viable and effective treatment for end stage heart failure non-responsiveto medical treatment. However, right heart failure (RHF) post LVAD with need for temporary or permanent right ventricular assist device (RVAD) is believed to reduce overall survival. We analyzed outcome of LVAD implantation aiming to identify predictors of perioperative RHF. Methods: From January 2010 to July 2014, 60 patients underwent LVAD implantation with the HVAD device. We retrospectively assessed echocardiographic parameters for RV function and right-heart catheter measurements. Univariate and multivariate analysis were performed to identify predictors of perioperative RHF after LVAD implantation. Cases of isolated RVAD and planned BVAD implantation were excluded. Results: Additional RVAD after LVAD implantation was necessary in 17 cases (28.3%) for temporary (n = 13, 21.7%) or permanent (n = 4, 6.7%) RHF. The 30-day mortality was significantly higher in patients with RHF (n = 7, 41.2%) than in patients without RHF (n = 4, 9.3%; p = 0.005). Baseline demographic parameters, such as mean age and gender were not different between the two cohorts (52.1 ± 12.0 years versus 57.1 ± 12.6 years in the LVAD cohort, p = 0.172; 4.8% female versus 11.6% in the LVAD cohort, p = 0.783). INTERMACS levels showed significantly higher acuity in patients requiring RVAD (2.3 ± 0.8) than in patients not requiring RV support (3.0 ± 0.9; p = 0.031). Patients with preoperative ECMO support were more likely to need additional RVAD therapy (p < 0.001) and 30-day mortality was significantly higher in these patients (35.7% versus 13.0%; p < 0.001). Echocardiographicly increased RVEDD/LVEDD ratio predicted RHF requiring RVAD support (0.6 ± 0.2 versus 0.4 ± 0.1; p = 0.029). None of the right heart catheter measurements revealed predictive value. Conclusion: In this study we found that a high RVEDD/LVEDD ratio in pre-operative echocardiography predicted increased risk for perioperative RHF after LVAD Implantation. It might be a useful guide for preoperative conditioning, since need for RVAD support is associated with markedly decreased perioperative survival. Additionally, patients with high INTERMACS acuity and prior ECMO support are at risk for perioperative RHF.