Right Ventricular Longitudinal Strain In Left Ventricular Assist Device Surgery-A Retrospective Cohort Study.

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Echocardiography

Background:

• Right ventricular (RV) failure is a significant complication following left ventricular assist device (LVAD) implantation, contributing to increased mortality.
• Quantifying RV function is crucial for predicting patient outcomes after LVAD surgery.
• Intraoperative transesophageal echocardiography (TEE) offers a potential method for assessing RV function.

Purpose of the Study:

• To investigate the association between pre-operative RV longitudinal strain, measured by TEE, and adverse outcomes in patients undergoing LVAD implantation.
• To test the hypothesis that depressed RV strain predicts poor outcomes.

Main Methods:

• Retrospective cohort study involving adult patients who received a non-pulsatile LVAD.
• Intraoperative TEE was used to measure peak RV free wall longitudinal strain.
• Adverse outcomes were defined as a composite of death, prolonged inotrope use, mechanical RV support, or device thrombosis within 6 months.
• Logistic regression analysis was employed to assess the relationship between RV strain and adverse events.

Main Results:

• A total of 57 patients were included, with 37% experiencing at least one adverse outcome.
• Inter-rater agreement for RV strain measurements was moderate (ICC 0.62, Pearson 0.63).
• No significant association was found between peak longitudinal RV strain and the composite adverse outcome within 6 months post-surgery.

Conclusions:

• Peak longitudinal RV strain, as assessed by intraoperative TEE, is not a reliable predictor of adverse outcomes in patients undergoing non-pulsatile LVAD implantation.
• The study suggests that other quantitative echocardiographic measures may be more effective for intraoperative RV assessment.
• Further investigation into novel echocardiographic techniques for RV evaluation in LVAD patients is warranted.