Abstract 18182: Intra-Aortic Balloon Pump Improves Right Ventricular Function in Patients with End-Stage Congestive Heart Failure

Abstract

Objective: Right ventricular dysfunction is a major contraindication for implantation of left ventricular assist device (LVAD) in patients with end stage heart failure (HF). The objective of the study was to investigate the effect of prolonged IABP support on anatomy and function of right ventricle (RV) in patients with idiopathic dilated cardiomyopathy (IDM) and end-stage HF. Methods: We recorded the baseline characteristics and the course of the echocardiography indices of right ventricular function in patients with IDM and HF ineligible for LVAD implantation who underwent support with IABP as bridge to candidacy in our hospital between May 2009 and Nov 2012. Results: During this period, 15 patients (mean age 49.3 ± 14.2 years) underwent support with IABP for a mean period of 91.1 ± 55.1 days [range 21-215 days]. All patients suffered from IDM and were severely symptomatic (New York Heart Association class IV). Nine patients (60%) were in INTERMACS level II while the other six were in INTERMACS level 1. Mean left ventricular ejection fraction, pulmonary capillary wedge pressure, cardiac index, BNP, and daily furosemide dose were 21.6 ± 7.3%, 24.8 ± 6.0 mmHg, 1.43 ± 0.33 L/min/m 2 , 2468 ± 1201 pg/ml και 801 ± 608 mg. The support with IABP led to reduction of right ventricular dimensions (RV base from 42.4 ± 2.3 to 37.7 ± 7.9 mm, p=0.24, mid RV from 33.7 ± 5.7 to 27.4 ± 7.2 mm, p=0,001) and to amelioration of systolic function (max velocity of the tricuspid annulus [Sm] from 9.1 ± 1.9 cm/s to 11.3 ± 2.1 cm/s, p=0.006). Right ventricular stroke work index (RVSWI), a valuable marker of intra-operative mortality demonstrated significant increase (from 352.6 ± 217.3 to 557.5 ± 136.2 mmHg x ml/m 2 , p=0.022). Even IVA, an indice which reflects RV myocardial contractility , largely independent of loading conditions also increased with IABP support (from 0.76 ± 0.35 m/s 2 to 1.43 ± 0.69 m/s 2 , p=0.043, [Normal values: 1.4 ± 0.5 m/s 2 ]). Conclusion: Support with IABP of end stage HF patients with dilated cardiomyopathy improves RV function, potentially rendering patients previously ineligible for LVAD to candidates for this life saving treatment.