Impact of Right Ventricular Performance Load Dependency on Preoperative Prediction of Postoperative Right Heart Function in Patients Who Need a Left Ventricular Assist Device

Abstract

Purpose Left ventricular assist devices (LVADs) provide better quality of life than biventricular devices, but it is a challenge to evaluate RV function and to predict its time-course during LV support. RV failure after LVAD insertion is related to preoperative RV geometry and tricuspid regurgitation (TR), both highly load sensitive. We assessed the impact of load depedency in RV performance to improve future decision making. Methods and Materials In patients with LVAD implantation after 1/2006, RV anatomic and functional parameters plus pulmonary hemodynamic data were prospectively collected by echocardiography and heart catheterization before LVAD implantation in order to test their relationship with postoperative RV function and patient outcome. Results After LVAD implantation 45 of 475 evaluated patients showed RV worsening which necessitated mechanical support also for the RV. There were significant differences in preoperative RV short/long axis (S/L) and long axis/length-area (L/Area) ratios, tricuspid annulus systolic velocity (TAPSm), RV peak systolic longitudinal strain rate (PSLSr), pressure gradient between RV and right atrium (ΔP RV-RA ), TR velocity-time integral (VTI TR ) and pulmonary arterial pressure (PAP) between the two patient groups (p RV-RA RV-RA ≥35mmHg showed high predictive values (≥ 90%) for post-operative freedom from RV failure. Conclusions RV geometry and velocity of contraction before LVAD implantation become more predictive for postoperative RV function if preoperative RV pressure-load and TR are also considered. S/L or L/Area ratio, TAPSm and PSSr, in connection with either maximum ΔP RV-RA or VTI TR can improve decision making before VAD implantation.