Predicting right ventricular failure in the modern, continuous flow left ventricular assist device era

Area of Science:

• Cardiology
• Medical Devices
• Surgical Outcomes

Background:

• Distinguishing between isolated left ventricular assist device (LVAD) and biventricular support (BIVAD) is challenging in the continuous flow LVAD era.
• Delayed BIVAD implantation increases patient morbidity and mortality.
• Continuous flow LVADs can improve right ventricular (RV) function and decrease pulmonary hypertension.

Purpose of the Study:

• To identify preoperative predictors for isolated LVAD versus BIVAD therapy.
• To develop a risk stratification tool for determining the need for biventricular support.

Main Methods:

• Retrospective review of 218 patients undergoing VAD implantation (2003-2011).
• Analysis of demographic, hemodynamic, laboratory, and echocardiographic variables.
• Multivariable logistic regression to identify predictors of BIVAD requirement.

Main Results:

• Seventeen of fifty preoperative risk factors were statistically significant.
• Key predictors for BIVAD need included elevated central venous pressure, severe RV dysfunction, preoperative intubation, severe tricuspid regurgitation, and tachycardia (CRITT criteria).
• A novel risk score demonstrated superior performance compared to existing tools for predicting RV failure.

Conclusions:

• A new preoperative risk calculator effectively determines patient suitability for isolated LVAD support.
• This tool aids in decision-making for VAD therapy in the continuous flow era.