Abstract 18958: High Pre-Operative Right Atrial Pressure to Pulmonary Capillary Wedge Pressure Ratio is Not Associated With Right Ventricular Dysfunction After LVAD Implantation

Abstract

Background: High RA pressure (RAP) to pulmonary capillary wedge pressure (PCWP) ratio has been associated with right ventricular (RV) failure after left ventricular assist device (LVAD) placement. This predictor has performed variably in external validation sets and RV failure after LVAD remains difficult to predict. We sought to determine the relationship between pre-operative RA:PCWP ratios and post-LVAD hemodynamic measures of RV function. Hypothesis: A high pre-operative RAP:PCWP ratio will be associated with RV dysfunction by invasive hemodynamics (high RAP, low cardiac index) after LVAD implantation. Methods: Right heart catheterization and other hemodynamic variables were collected both pre and post (within 48-72 hours) LVAD implantation on a cohort of 69 patients with end stage systolic heart failure. Patients were divided into 3 groups based on pre-operative RAP:PCWP ratios and pre and post-op hemodynamic data was analyzed by group. Results: Pulmonary vascular resistance (PVR) was higher and pulmonary artery capacitance (PAC) was lower in patients with the highest pre-operative RAP:PCWP ratios. There was no difference in post-LVAD RA pressure, cardiac index, or PCWP between RAP:PCWP groups (Table). In fact, higher pre-operative RAP to PCWP ratios were associated with the larger decreases in RA pressure post LVAD, with each 0.1 increase in pre-operative RAP:PCWP ratio being associated with a 1.7 mm Hg decrease in RA pressure post LVAD (p < 0.0001). Conclusions: High pre-operative RAP:PCWP ratios were associated with the largest drop in RA pressure after LVAD implantation. While high RAP:PCWP ratios have previously been associated with RV failure, in the presence of increased RV afterload, this seemed to predict a favorable hemodynamics response and should not preclude LVAD implantation.