Preoperative and perioperative predictors of right ventricular failure after left ventricular assist device implantation

Background: Right ventricular (RV) failure is a serious adverse event for patients with left ventricular assist devices (LVADs). Here, we seek to identify the risk factors which may predict the development of RV failure (RVF). Methods and Results: Forty-two patients were implanted with LVADs (32 HeartWare® ventricular assist device and 10 Thoratec® HeartMate II) between March 2013 and April 2014 at the Ege University Medical School, Izmir, Turkey. Baseline clinical, demographic, and laboratory information were measured and patients prospectively fallowed after surgery. Endpoint was defined RVF development for patients. Before surgery, hemodynamic parameters, electrocardiographic findings, standard echocardiographic measurements, and medications were recorded. Multivariate regression analysis showed that the presence of ascites, prealbumin <14 mg/dl, bilirubin >1.5 mg/dl, RV diameter >3.2 cm, RV-fractional area change (FAC) <24%, right atrial area (RAA) >28 cm, 2 and RV-myocardial performance index >0.35 were the strongest predictors of RVF after LVAD implantation. Conclusions: RAA and RV-FAC are easily obtained and should be evaluated in potential LVAD patients. Risk assessment systems should also take into account the presence of ascites and low prealbumin levels which are not currently incorporated into any risk models. Validation of the relative importance of all of these parameters requires further investigation.