Baseline Characteristics and Right Ventricular Failure
Table 1 shows the comparison of patients’ characteristics, preoperative
echocardiographic and hemodynamic variables, and operative details in 10
patients that developed late right ventricular failure (RVF +) and 28
patients without late RVF (RVF -) after LVAD implantation. The mean age
was 56,1 ± 6,9 years in the first group and 56 ± 9 years in the second
one (p=0,973). Six patients in the second group (21%) were female.
Idiopathic dilated cardiomyopathy was seen in 8 RVF + patients (80%)
and in 12 RVF - patients (42%), p=0,053. Ischemic cardiomyopathy was
diagnosed in 2 patients (20%) of the RVF + group and in 16 (57%) of
the RVF - group, p=0,048. Most of these patients, 80% RVF + and 67 %
RVF -, had received inotropic therapy before LVAD implantation, and a
large part was in INTERMACS class 3. All of the patients belonging to
the RVF + group received LVAD therapy as Bridge to Transplant (BTT). We
compared preoperative echocardiographic variables, data obtained with
right heart catheterization, and preoperative laboratory variables of
the two groups. There were no statistical differences in
terms of preoperative echocardiographic measurements, including
the grade of mitral, tricuspid and aortic regurgitation, left
ventricular end-diastolic dimension, left ventricular ejection fraction,
and tricuspid annular systolic excursion (TAPSE). Preoperative
laboratory data, including hemoglobin, blood urea nitrogen, AST, ALT,
total bilirubin, white blood cells count, creatinine, albumin, INR, and
brain natriuretic peptide level, also revealed no significant difference
between the groups. The preoperative right catheterization findings,
including cardiac index, pulmonary vascular resistance, CVP, PCWP were
also similar between the groups; however, RV stroke work index was
significantly lower among patients with RVF after LVAD implantation. Of
the 10 patients in the RVF + group, 8 had frequent suction events. 5
patients were readmitted for concomitant frequent low flow events with
PF <3L / m. 2 patient arrived in hospital suffering from
recurrent episodes of ventricular fibrillation (FV). For all patients
the echocardiographic control confirmed the leftward shift of SIV and
moderate-severe right ventricle disfunction. In 4 patients a LVEDD
< 3 cm was found. Moderate IT and an estimated CVP
> 15 mm Hg were present in 6 patients. In 2 patients, IT
was judged to be severe with CVP value> 25 mmHg. 5 patients
required diuretic therapy and speed optimization. in 3 patients
inotropic support with adrenaline 0.05 µg / kg / min was started and
progressively reduced until recovery obtained, then the medical
treatment was optimized. 2 patients with severe right ventricular
failure required prolonged continuous veno-venous hemofiltration and
high dosage inotropic support.