Abstract 19809: Intrinsic Right Ventricle Dysfunction is a Major Cause of Post LVAD Mortality

Abstract

Background: Right ventricular (RV) dysfunction after left ventricular assistant device (LVAD) confers significant challenges for post-device managements and increases mortality. The purpose of this study was to test the hypothesis that intrinsic RV myocardial dysfunction measured by 2-D echocardiography speckle tracking imaging prior to LVAD implantation is the most common cause of post-LVAD failure. Methods: Thirty-nine patients who underwent Heartmate II LVAD placement from 2010 to 2011, and 10 age-matched controls were studied. Pre- and post-operative clinical, and echocardiographic data were prospectively collected for LVAD database. RV longitudinal myocardial velocity, strain, and strain rate were measured retrospectively using an off-line speckle-tracking analysis software. Results: Of the 39 LVAD recipients, 24 patients developed acute RV failure immediately post LVAD implantation, among which 13 patients recovered from RV dysfunction after LVAD adjustment and medical management, while 11 patients with intrinsic RV dysfunction as identified by significantly lower global RV peak myocardial velocity, strain, and strain rate prior to LVAD (p<0.05), eventually required RVAD and/or death despite optimal medical therapy. Intrinsic RV myocardial dysfunction often cannot be completely improved by LVAD implantation alone and may be exaggerated by septal shifting caused by emptying or decompressing LV, thus, worsening severe or deteriorating RV dysfunction which eventually requires RVAD or leads to death. Eight of 11 patients including all 7 RVAD patients died within 6 months from LVAD implantation had a peak longitudinal systolic RV global strain of -3% or lower (absolute value). Twenty-four of 27 (88%) patients with the global RV strain higher than -3% (absolute value) survived without RVAD (p<0.05). Conclusions: Poor intrinsic RV myocardial function is often worsened in LVAD patients and is a leading cause for a high LVAD mortality.