154 - Hemodynamics Predictors of INTERMACS Defined Early Right Ventricular Failure after Left Ventricular Assist Devices

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Introduction: Right heart failure (RHF) is a frequent complication following left ventricular assist device (LVAD) implantation and is a major factor of postoperative morbidity and mortality. However, identifying LVAD patients at risk for RHF postoperatively still remains an unsolved problem. The objective of our study is to identify preoperative hemodynamics predictors of RVF during LVAD support. Methods: Patients who underwent implantation of Heartmate II or Heartware LVADs at our center between December 2011 and December 2016 were identified. Early RVF was defined according to the latest INTERMACS definition based upon both documentation of elevated central venous pressure (CVP) and manifestations of elevated CVP before discharge. Severity was further stratified according to duration of inotrope/IV vasodilator/iNO therapy as mild (≤7 days), moderate (8–14 days), and severe (>14 days or need from mechanical RV support). Results: Among 111 patients (98 male, median 64.6 years old) who underwent LVAD implantation with 88 HeartMate II (74.6%) and 28 Heartware (23%), 75 (66.4%) experienced early RV failure. Of the 75 patients who met the INTERMACS RHF definition, 32 had mild RHF (42.7%), 27 had moderate RHF (36%), and 16 had severe RHF (21.3%). Population was stratified according to moderate-severe RVF vs mild RVF. Pre-LVAD hemodynamics demonstrated significant differences in patients who experienced moderate-severe acute RHF: right atrial pressure (RAP) (14.5 Vs. 9.00 P < .002), mean pulmonary pressure (MPAP) (40.5 Vs. 35.0 P < .025) and central venous pressure (CVP)/pulmonary capillary wedge pressure (PCWP) (0.55 Vs. 0.41 P < .034). By univariate analysis RAP, MPAP and RAP/PCWP were significantly associated with risk of moderate/severe RHF. In a multivariable model only MPAP and CVP/PCWP were significantly predictive of RHF. Area under the curve analysis demonstrated MPAP (0.684) and CVP/PCWP (0.724). Conclusions: Pre-LVAD hemodynamic data can be used to stratify patients post-LVAD implantation at risk for moderate-severe RHF. This is first study to investigate the importance of pre-LVAD hemodynamics predicting early moderate or severe RHF defined using the new INTERMACS definition.