0377: Can we predict right heart failure after implantable left ventricular assist device?

Abstract

The right ventricular failure (RVF) is a severe complication after implantation of a left ventricular assist device (LVAD), difficult to predict and treat. The purpose of this study was to identify risk factors of RVF after mechanical circulatory support. This is a single-center prospective cohort of patients with long-term electrical intracorporeal continuous flow LVAD type HeartMate II between January 2008 and September 2014. We searched predictors of RVF, defined by a need of inhaled nitric oxide ≥48 hours and / or intravenous inotropes ≥14 days. 42 devices were implanted in 36 men and 6 women with a mean age of 57.3 years, for 30 ischemic and 12 primitive cardiomyopathies, 10 cases in “Destination Therapy” and 32 cases in “Bridge-to-Transplantation.” The 30-day mortality was 6 patients, 1-year survival of 84%, the mean last of intubation was 7 days and ICU stay of 16.3 days. There were 16 cases of RVF (38.1%). The significantly associated factors (p<0.05) were: subaortic time velocity integral (10.5 versus 13.8cm), grade (1.4 versus 0.3) and maximal speed of the triscuspid regurgitation (3 versus 3.5 m/s), fractional shortening (27 versus 36.4%) and surface of the right ventricle (33.4 versus 22cm 2 ), capillary (26.3 versus 18.3mmHg) and mean pulmonary arterial pressures (38.7 versus 27.2mmHg), transpulmonary gradient (14 versus 8.5mmHg), pulmonary arterial resistances (3.7 versus 2.7 UW), right ventricular (26 versus 8.1mmHg) and atrial pressures (11 versus 5.5mmHg), bilirubin (28.3 versus 15.7 µmol/l), INTERMACS score (3.3 versus 4.4), non-ischemic etiologies (50 versus 85%) and preoperative inotropic drugs (56 versus 15%). RVF remains a major complication in implantable LVAD. According to the literature, preoperative pulmonary hypertension, right systolic dysfunction and cavitary dilation seem to favor its appearance.