Definition and Management of Right-Side Heart Failure
The primary outcome was late RVF after pump speed optimization during
the follow-up period after LVAD implantation. Patients underwent
standard treatment to prevent RVF after LVAD implantation.
These included:
1) maintaining optimal preload by preserving euvolemia;
2) optimizing pump speed to achieve maximum cardiac output, without the
development of complications associated with excessive pump speeds.
During the optimization test, echocardiographic images were obtained at
incremental speed settings with steps of 100rpm. Optimal pump speed was
defined as the highest speed that allowed intermittent aortic valve
opening and neutral interventricular septum position without increased
aortic or tricuspid regurgitation or RV dilatation;
3) maintaining mean arterial pressure in the range of 75- 85 mmHg.
Late right ventricular failure was defined when the following parameters
were found:
- Leftward shift of interventricular septum (SIV), MAP < 65
mmHg; CVP > 15 mmHg;
- LVAD flow < 3.5 L / m;
- Moderate-severe Tricuspid Regurgitation (TR);
- Frequent suction events.
When a moderate right function was diagnosed, intravenous diuretic
therapy and aggressive fluid removal was started. Patients admitted with
signs of severe right ventricular failure received inotropic support and
high dosage diuretic therapy. When a severe right sided volume overload
was found , fluid removal by continuous veno-venous hemofiltration
(CVVH) was necessary.