Preoperative Ascites Predicts Right Ventricular Failure post-LVAD Implantation

Abstract

Introduction Preoperative cardiac ascites has been shown to be a predictor of mortality in the latest INTERMACS report. However, it has not been shown to be an independent risk factor for the development of RVF after LVAD implantation. Hypothesis Pre-operative ascites on imaging during implant admission is associated with post-operative RVF. Methods We performed a single-center retrospective study of 153 patients who received a continuous-flow durable LVAD between 1/2006 and 12/2016 and who also had preoperative abdominal ultrasound or CT aduring implant admission. Severe RVF was defined as meeting criteria for clinical RVF and having inotropes > 14 days after implant, inotropes re-started 14 days after implant, RVAD implant, and death from RVF. The severity of ascites was extracted from the radiology reports and was graded as either none/trace, mild, moderate, or severe. A multivariate analysis of pre-operative ascites stratified by severity and post-implant RVF was performed. Results In our 153 patient cohort, 43 (28.1%) were found to have significant ascites, with 35 (22.9%) having mild ascites, 8 (5.6%) having moderate ascites, and 0 having severe ascites. Patients with ascites had higher preoperative total bilirubin, lower platelet count, higher mean RA pressure, higher mean PA pressure, lower pulmonary artery pulsatility index (PAPi), higher PCWP, and higher mortality rate, p Table 1 ). The multivariable model (which included age, INTERMACS level, creatinine, gender, and total bilirubin) found that preoperative ascites (OR 1.98, 95% CI [1.02 - 3.81], p = 0.04) and total bilirubin (OR 1.50, 95% CI [1.07 - 2.10], p = 0.018) were independent predictors of post-implant RVF. The ROC curve of ascites and post-operative RVF had a c-statistic of 0.72 ( Figure 1 ). Conclusion The preoperative presence of ascites correlates with post-operative RVF. Abdominal imaging could be useful in further risk stratifying patients for post-implant RVF.