98: The Influence of the Inflow Cannula Length in Rotary Blood Pumps on the Neurological Adverse Event Rate – Results from a Multi-Center Analysis

Abstract

Purpose: Right ventricular (RV) failure after left ventricular assist device (LVAD) placement is a serious complication with a poor prognosis and is difficult to predict. In the era of LVAD use as destination therapy and alternatives such as the total artificial heart, predicting post-LVAD RV failure requiring mechanical support is extremely important. Methods and Materials: We reviewed patient characteristics, laboratory values, and hemodynamic data from 266 patients who underwent LVAD placement at the University of Pennsylvania from April 1995 to June 2007. Results: Of 266 LVAD patients, 99 required RV assist device (BiVAD) placement (37%). We compared 36 parameters between LVAD (n 167) and BiVAD patients (n 99) to determine preoperative risk factors for RV assist device (RVAD) need. By univariate analysis, 23 variables showed statistically significant differences between the two groups (P 0.05). The strongest of these were female gender, low body surface area, echocardiographic evidence of severe preoperative RV dysfunction, previous cardiac surgery, preoperative mechanical ventilation, elevated creatinine, elevated INR, elevated central venous pressure, low systolic blood pressure (SBP), low pulmonary artery systolic and mean pressures, low cardiac index (CI), low mixed venous oxygen saturation, and low right ventricular stroke work index (RVSWI). By multivariate logistic regression, CI 2.3 L/min m (odds ratio [OR] 5.7), RVSWI 0.25 mmHg mL/m (OR 5.1), severe preoperative RV dysfunction (OR 5.0), preoperative creatinine 1.9 mg/dL (OR 4.8), previous cardiac surgery (OR 4.5), and SBP 96 mmHg (OR 2.9) were the best predictors of RVAD need. Conclusions: The most significant predictors for RVAD need were CI, RVSWI, severe preoperative RV dysfunction, creatinine, previous cardiac surgery, and SBP. Using these factors, we have constructed an algorithm which can predict which LVAD patients will require RVAD with greater than 80% sensitivity and specificity.