Acute right ventricular geometric change predicts outcomes in HeartMate 3 patients

Abstract

BackgroundThe physiological response of the right ventricle (RV) following left ventricular assist device (LVAD) implantation is difficult to predict. We aimed to investigate RV geometric and functional changes after LVAD insertion and their effects on clinical outcomes. MethodsWe retrospectively reviewed 188 patients who underwent HeartMate 3 implantation at our center between November 2014 and September 2021. The RV end-diastolic diameter (RVEDD) and area (RVEDA) were measured on preoperative and pre-discharge transthoracic echocardiography. The non-adapted group included patients with increased RVEDD and RVEDA at discharge. The composite outcome was defined as death or readmission due to worsening right heart failure. ResultsThere were 82 patients (44%) who had a non-adapted and 106 (56%) who had an adapted RV. Preoperatively, the non-adapted group had smaller RVEDD (46 vs. 49 mm, p < 0.001) and RVEDA (27 vs. 31 cm2, p < 0.001). At discharge, the non-adapted group had larger RVEDD (51 vs. 43 mm, p < 0.001) and RVEDA (33 vs. 27 cm2, p < 0.001). Kaplan-Meier analysis demonstrated worse 3-year survival (77% vs. 91%, p = 0.006) and freedom from composite outcome (58% vs. 85%, p < 0.001) in the non-adapted group. A multivariable Cox proportional hazards model showed that non-adaption (HR 3.09, 95% CI 1.29–7.40 p = 0.01) and age (HR 3.73, 95% CI 1.42–9.77, p = 0.007) were independent predictors of composite outcome. ConclusionsAcute RV dimensional changes after LVAD insertion may represent intrinsic RV function and may be a useful prognostic marker.