Abstract 9794: Load Dependency of Right Ventricular Performance is a Major Factor to be Considered in Decision Making Prior to Ventricular Assist Device Implantation
Background Left ventricular assist devices (LVADs) provide better quality of life than biventricular devices (BVADs), but it is a challenge to evaluate right ventricular (RV) function and to predict its time-course after LV support. Severe RV failure after LVAD implantation appeared related to pre-operative RV geometry and tricuspid regurgitation (TR) which are highly load sensitive parameters. We assessed the impact of load dependency on RV performance before and after LVAD implantation aiming to improve pre-operative decision making.
Methods We evaluated our patients who received a LVAD after 1/2006. RV anatomic and functional parameters collected prospectively before LVAD implantation and invasively collected data on pulmonary hemodynamics were tested for relationship with post-implant RV function and patient outcome. Echocardiography including tissue Doppler and 2D strain imaging was used to evaluate RV size, geometry and function.
Results After LVAD implantation 45 (9.5%) of 475 evaluated patients showed worsening of RV function which necessitated a mechanical support also for the RV. Whereas RVEF was similar in patients with and without stable post-operative RV function there were significant differences in pre-operative long/short axis (L/S) ratio, tricuspid annulus peak systolic velocity (TAPSm) peak global strain rate (RVSSr),RV/right atrial pressure gradient (ΔP-RV/RA) and pulmonary arterial pressure (PAP) between the two patient groups (p < 0.05). The highest predictive values (up to 93.5%) for RV failure after LVAD insertion were found for pre-operative L/S ≥ 0.6, TAPSm < 8cm/s, and peak RVSSr < 0.7/s in patients with maximum ΔP-RV/RA < 35mmHg. L/S, TAPSm and RVSSr also showed high predictive values for RV failure in patients with preoperative TR > grade II and PAP < 50mmHg. L/S < 0.6, TAPSm ≥ 8cm/s, and peak RVSSr ≥ 0.7/s in patients with maximum ΔP-RV/RA ≥ 35mmHg showed high predictive values (≥ 92%) for postoperative freedom from RV failure.
Conclusion RV geometry and velocity of contraction before LVAD implantation are highly predictive for postoperative RV function if preoperative PAP and TR are also considered. RV L/S ratio, TAPSm and RVSSr, in connection with maximum ΔP-RV/RA, can improve decision making before VAD implantation.
- © 2012 by American Heart Association, Inc.