Preoperative risk factors for right ventricular failure after implantable left ventricular assist device insertion

Background. Implantable left ventricular assist device (LVAD) insertion com plicated by early right ventricular (RV) failure has a poor prognosis and i s generally unpredictable. Methods. To determine preoperative risk factors for perioperative RV failur e after LVAD insertion, patient characteristics and preoperative hemodynami cs were analyzed in 100 patients with the Hearth late LVAD (Thermo Cardiosy stems, Inc, Woburn, MA) at the Cleveland Clinic. Results. RV assist device support was required for II patients (RVAD group) . RVAD use was significantly higher in younger patients, female patients, s maller patients, and myocarditis patients. There was no significant differe nce in the cardiac index, RV ejection fraction, or right atrial pressure be tween the two groups preoperatively. The preoperative mean pulmonary arteri al pressure (PAP) and RV stroke work index (RV SWI) were significantly lowe r in the RVAD group (p = 0.015 and p = 0.011, respectively). Survival to tr ansplant was poor in the RVAD group (27%) and was 83% in the no-RVAD group. Conclusions. The need for perioperative RVAD support was low, only 11%. Pre operative low PAP and low RV SWI were significant risk factors for RVAD use . (C) 1999 by The Society of Thoracic Surgeons.