Abstract 11414: Temporary Right Ventricular Mechanical Support in Addition to a Left Ventricular Assist Device: When is It Required and When is Its Removal Feasible?
Background: Right ventricular failure (RVF) before, during and after left ventricular assist device (LVAD) insertion is associated with high mortality. Thus, preoperative (preop) distinction between impaired RVs with and without the potential for recovery during RV afterload reduction by an LVAD is paramount. During biventricular support, RV recovery allowing RVAD removal can occur after unloading by a temporary device but preop prediction of recovery, its postoperative (postop) assessment and the timing of RVAD removal are challenging.
We analyzed these issues to improve preop decision making.
Methods: To assess the predictability of RV recovery during LVAD or LVAD+RVAD support allowing RVF free outcome without RVAD, prospectively gathered data on preop RV size, shape and function, tricuspid regurgitation and pulmonary hemodynamics were tested for relationship with postop RV function. Right heart catheterization and echo variables collected during short stops of the RV pump were used to test the predictability of weaning success from RV support.
Results: Of 283 evaluated pts (preop RVEF ≤ 30%), 235 received an LVAD (group A) and 48 LVAD+RVAD (group B). We compared in group A the preop data from pts with and without postop RVF and in group B those from pts with and without RV recovery during biventricular support. We found less altered RV size and shape, higher velocity of RV systolic wall motion and myocardial shortening and higher systolic pressure gradients between RV and right atrium in pts with no RVF during LVAD support and also in those with RVAD-promoted RV recovery (p < 0.01). Combined assessment of myocardial velocity of shortening and RV size and geometry in relation to RV load showed the highest predictive values (83-97%) for preop distinction between impaired RVs with and without the potential to remain free from RVF after LVAD insertion or the potential to recover during RVAD support, and also for postop distinction between unloading promoted RV recovery with and without the potential to remain stable after RVAD removal.
Conclusions: Preoperative assessment of RV ability to improve during LVAD ± temporary RVAD support and prediction of weaning results before RVAD removal can be improved by evaluation of RV size, shape and function in relation to RV load.
Author Disclosures: M. Dandel: None. E. Potapov: None. T. Krabatsch: None. B. Jurmann: None. C. Knosalla: None. R. Hetzer: None.
- © 2014 by American Heart Association, Inc.