Related Experiment Video
Updated: Oct 13, 2025
Implantation of the Syncardia Total Artificial Heart
Published on: July 18, 2014
The impact of left ventricular size on outcomes after centrifugal-flow left ventricular assist device implantation
Ezequiel Molina1,2, Amiti Jain1, Sara Ahmed3
1Department of Cardiac Surgery, Medstar Washington Hospital Center, Washington, DC, USA.
Insights
Smaller left ventricular end-diastolic dimension (LVEDD) in patients receiving a left ventricular assist device (LVAD) is linked to worse survival and more complications. This finding impacts patient selection and management for LVAD implantation.
Area of Science:
- Cardiology
- Mechanical Circulatory Support
- Cardiac Surgery
Background:
- Preoperative left ventricular size is a critical factor in outcomes for patients undergoing left ventricular assist device (LVAD) implantation.
- The specific influence of preoperative left ventricular size, particularly end-diastolic dimension (LVEDD), on outcomes following centrifugal-flow LVAD implantation requires further characterization.
Purpose of the Study:
- To investigate the association between preoperative left ventricular end-diastolic dimension (LVEDD) and patient outcomes after centrifugal-flow LVAD implantation.
- To identify a potential LVEDD cut-off point that predicts adverse outcomes in this patient population.
Main Methods:
- Analysis of a cohort of 313 patients who received a centrifugal-flow LVAD at a single institution.
- Utilized a maximally selected log-rank statistic to determine an optimal LVEDD cut-off point for predicting outcomes.
- Stratified patients into two groups based on the identified LVEDD cut-off (≤59 mm vs. >59 mm) for comparative analysis.
Main Results:
- A left ventricular end-diastolic dimension (LVEDD) cut-off of 59 mm was identified as a predictor of worse survival.
- Patients with smaller LVEDD (≤59 mm) exhibited significantly lower survival rates at 1 and 2 years compared to those with larger LVEDD (>59 mm).
- The smaller LVEDD group experienced higher rates of temporary right ventricular mechanical support, late right ventricular failure, gastrointestinal bleeding, and readmissions due to low-flow alarms.
Conclusions:
- Smaller preoperative left ventricular end-diastolic dimension (LVEDD ≤59 mm) is associated with diminished survival following centrifugal-flow LVAD implantation.
- Patients with smaller LVEDD face an increased incidence of adverse outcomes, including right ventricular failure and device-related complications.
- Preoperative LVEDD is an independent predictor of survival, alongside age, BUN, and bilirubin levels, in LVAD recipients.
Objectives:
The influence of preoperative left ventricular size in outcomes following centrifugal-flow left ventricular assist device (LVAD) implantation has not been well characterized.
Methods:
A cohort of 313 patients who received a centrifugal-flow LVAD at a single institution was analysed. Using a maximally selected log-rank statistic, we investigated whether a left ventricular end-diastolic dimension (LVEDD) cut-off point was associated with worse outcomes. The cohort was then divided in 2 groups based on the LVEDD cut-off point.
Results:
An LVEDD cut-off point of 59 mm was found to predict worse survival. Smaller LVEDD patients (≤59 mm, N = 52) were older and more likely to have a history of coronary artery disease compared those with a larger LVEDD (>59 mm, N = 261). Smaller LVEDD patients had lower survival compared to larger LVEDD patients (71% vs 85% at 1 year and 58% vs 80% at 2 years, P = 0.003). The need for temporary right ventricular mechanical support was significantly higher in the smaller LVEDD cohort (11.5% vs 1.9%, P = 0.002). Pump flows at time of discharge were lower in the smaller LVEDD group (3.8 vs 4.2 l/min, P = 0.005), who also had a higher incidence of late right ventricular failure (23% vs 12%, P = 0.02), higher rates of gastrointestinal bleeding (0.416 vs 0.256 events per patient-year, P = 0.025) and higher readmissions secondary to low flow alarms (0.429 vs 0.240 events per patient-year, P = 0.007). Multivariable analysis demonstrated that smaller LVEDD, older age, high BUN and high bilirubin levels were independent predictors of worse survival.
Conclusions:
In patients receiving a centrifugal-flow LVAD, smaller preoperative LVEDD (≤59 mm) was associated with lower survival and higher incidence of adverse outcomes.
Related Concept Videos
01:22Mitral Stenosis I: Introduction
01:29Cardiomyopathy V: Interprofessional Care
01:27Regulation of Stroke Volume
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling law of the...