Prediction of right ventricular failure after implantation of left ventricular assist devices

Aims: Right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation is a serious complication; its prediction prior to surgery remains difficult.

Methods: Forty consecutive patients who received an LVAD for chronic end-stage heart failure between 05/01 and 12/02 were evaluated. The patients were divided retrospectively into two groups: group I (n=26) with normal right ventricular function after LVAD implantation and group II (n=14) with RVF after LVAD implantation. Patients were defined as having RVF if two or more of the following criteria were met during the first 48 hours after LVAD implantation: mean arterial pressure <55mmHg, CVP >16mmHg, mixed venous saturation <55%, CI <2 l/min/m², inotropic support >20 units or need for right ventricular assist device. Echocardiographic, hemodynamic, neurohumoral and inflammatory parameters measured before LVAD implantation were analyzed.

Results: Right ventricular stroke work index was similar in both groups. In group I compared to group II lower levels of procalcitonin (0.106 vs. 0.322 ng/ml, p=0.048), neopterin (10.5 vs. 20.7 ng/ml, p=0.018), NT-proBNP (6322 vs. 17174 pg/ml, p=0.032), big endothelin-1 (1.6 vs. 19.5 pg/ml, p=0.02), and serum creatinine (1.2 vs. 1.9mg/dl, p=0.007) were measured. Mean arterial blood pressure was higher in group I than in group II (72 vs. 64mmHg, p=0.045).

Conclusion: Preoperative inflammation, neurohumoral activation, and renal dysfunction are predictive of RVF after LVAD implantation while echocardiographic and clinical parameters, with the exception of lower blood pressure, are not. In patients with elevation of the above parameters biventricular support should be considered.