Background. Right ventricular failure (RVF) is a severe event that increases perioperative mortality after Left Ventricle Assist Device (LVAD) implantation. RV function is particularly affected by the LVAD speed by changing RV preload and afterload as well as the position of the interventricular septum. However, there are no studies focusing on the relationship between pump speed optimization and risk factors for development of lateRVF. Methods. Between 2015 and 2019,50 consecutive patients received LVAD implantation at San Camillo Hospital in Rome. Of these, 38 who underwent pump speed optimization were included. Post optimization hemodynamic data were collected. We assessed: a new Hemodynamic Index (HI), calculated as follows HI=MAP x PCWP/CVP x RPM set/RPM max; risk factors for late RVF, which was defined as the requirement for 7 days or more of inotropic support. Results 10 patients had late RVF after LVAD implantation. 5 patients required diuretic therapy and speed optimization. In 3 patients inotropic support with adrenaline 0.05 g/kg/min was started. 2 patients required prolonged continuous veno-venous hemofiltration and high dosage inotropic support. Multivariate analysis revealed that a low HI (odds ratio 11.5, 95 % confidence interval,1.85-65.5,p[.003] was an independent risk factor for late RVF after LVAD implantation. Conclusion A low HI, according to our study, is a significant risk factor for the development of RVF after LVAD implantation. We suggest adopting this index during the follow-up to stratify the different hemodynamic profiles and modify the therapeutic strategies according to the different HI levels obtained for every single patient.
Pheochromocytoma is a rare catecholamine-secreting tumor derived from chromaffin cells in the adrenal glands. A pheochromocytoma ‘crisis’ (PCC) can cause haemodynamic instability and end-organ damage or dysfunction. An excessive stimulation of cardiac myocytes could lead to myocardial damage with cardiogenic shock (CS). Use of mechanical circulatory support (MCS) might find an indication in this scenario as a bridge to myocardial recovery. We present the case of a patient successfully supported with ECMO (ExtraCorporeal Membrane Oxygenation) combined with IMPELLA CP heart pump (Abiomed Danvers, MA), for left ventricular (LV) unloading. MCS was used to favour myocardial recovery and avoid cardiac remodeling.