Thorac Cardiovasc Surg 2014; 62 - OP71
DOI: 10.1055/s-0034-1367148

Risk factors predictive of therapy refractory right ventricular failure after continuous-flow left ventricular assist device implantation

J. Fatullayev 1, A. Sabashnikov 1, A.-F. Popov 1, B. Zych 1, M. Hedger 1, R. Hards 1, P. Mohite 1, F. De Robertis 1, T. Bahrami 1, M. Amrani 1, N.R. Banner 2, A.R. Simon 1
  • 1Royal Brompton & Harefield NHS Foundation Trust, Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield, London, United Kingdom
  • 2Royal Brompton and Harefield NHS Foundation Trust, Department of Heart Failure and Transplant Medicine, Harefield, London, United Kingdom

Objectives: Left ventricular assist devices (LVADs) are increasingly used for treatment of therapy refractory advanced heart failure. However, right ventricular failure (RVF) represents one of the devastating postoperative complications. Furthermore a substantial portion of patients may develop therapy refractory RVF requiring right sided mechanical support after LVAD implantation. The aim of this study was to evaluate predictors of therapy refractory RVF with the need for a right ventricular assist device (RVAD) support.

Methods: A total amount of 139 consecutive patients who received a continuous-flow LVAD between 06.2006 and 08.2013 were included in this study. 23% (n = 32) of patients required a short-term RVAD (RVAD-group) after operation whereas 77% (n = 107) did not develop RVF or could be managed with inotropic support (non-RVAD-group). Preoperative demographics and baseline clinical characteristics as well as intraoperative variables were compared. Multivariate regression analysis was performed to evaluate independent predictors of RVF requiring right sided mechanical support.

Results: Univariate analysis showed that the number of female patients in RVAD-group was significantly higher than in non-RVAD-group (37.7% vs. 11.2%, p = 0.002). Generally, the patients in RVAD-group had significantly faster heart rate (97 ± 20 vs. 86 ± 20 bpm, p = 0.014), lower height (169 ± 9 vs. 175 ± 9 cm, p = 0.001) and weight (71 ± 15 kg vs. 79 ± 15 kg, p = 0.016). Furthermore, patients in RVAD-group showed higher levels of white blood cells (p = 0.042) and CRP (p = 0.077), had higher temperature (p = 0.033) and more deranged liver function. Also, RVAD patients were more likely to suffer from peripheral vascular disease (9.4% vs. 0%, p = 0.012) and had a higher rate of preoperative short-term mechanical support (STMS) (25% vs. 4.7%, p = 0.001). Transfusion requirements were also significantly higher in the RVAD-group. Multivariate regression analysis revealed higher preoperative temperature (p = 0.045) and higher FFP use (p = 0.012) as the only independent predictors for RVF requiring RVAD.

Conclusion: Our experience reveals that preoperative inflammation or infection might be associated with significantly higher risk of postoperative RVAD dependency, and should be treated preoperatively, if possible. Also, particularly in patients with increased risk of RVF FFP use should be restricted to a minimum.