Prophylactic Right Ventricular Assist Device for High-Risk Patients Undergoing Valve Corrective Surgery

Area of Science:

• Cardiovascular Surgery
• Mechanical Circulatory Support
• Cardiac Surgery Outcomes

Background:

• Right ventricular failure (RVF) post-cardiac surgery is linked to adverse outcomes.
• Current treatments for RVF include afterload reduction, contractility optimization, and vasopressors.
• A novel strategy involving prophylactic right ventricular assist device (RVAD) insertion during valve surgery for high-risk patients is proposed.

Purpose of the Study:

• To evaluate the feasibility and outcomes of prophylactic RVAD insertion in patients undergoing valve surgery at high risk for RVF.
• To assess the safety and efficacy of this novel approach in preventing or mitigating RVF.

Main Methods:

• A cohort of 10 high-risk patients (severe RV dysfunction or pulmonary hypertension) underwent valve surgery with prophylactic RVAD insertion between 2014 and 2017.
• Patient characteristics and perioperative/postoperative outcomes were retrospectively reviewed.

Main Results:

• All 10 patients achieved successful RVAD implantation, support, and weaning, with survival to discharge.
• Echocardiography showed transient worsening of right ventricular function postoperatively, followed by recovery.
• Patients required minimal inotropic support; no extracorporeal membrane oxygenation was needed.
• Major complications included prolonged mechanical ventilation (40%), metabolic encephalopathy (10%), and sternal wound infection (20%).
• At a mean follow-up of 445 days, 88% of patients were in New York Heart Association functional class 1 or 2.
• Two late mortalities occurred.

Conclusions:

• Prophylactic RVAD insertion appears to be a viable strategy for supporting high-risk patients undergoing complex valve surgery.
• This approach may reduce the incidence and severity of perioperative RVF.
• Further research is warranted to confirm these findings in larger patient cohorts.