INTRODUCTION
Mechanical ventricular assistance systems are increasingly acquiring a pivotal role in the treatment of heart failure refractory to medical therapy [1]. The technological evolution has led to the development of remarkably reliable systems, also suitable for use as destination therapy in those who are not candidates for heart transplantation. Although these systems offer increasingly excellent safety profiles, lower risks of device failure, and improved blood compatibility, the prospect of left ventricular system supporting life long term is dependent on right ventricular (RV) function. Right ventricular failure (RVF) is a frequent and severe event that increases perioperative mortality after Left Ventricle Assist Device (LVAD) implantation. Previous reports revealed that the prevalence of RVF after LVAD implantation ranged from 10% to 40% [2-3-4]. To date, many studies have reported hemodynamic predictors of RVF including elevated central venous pressure (CVP), CVP/Pulmonary Capillary Wedge Pressure (PCWP) ratio, Right Ventricular Stroke Work Index (RVSWI), and Pulmonary Artery Pulsatility index (PAPi) [5-6-7]. Although these scores have possible utility in identifying preoperative features that increase the risk of right heart failure during left ventricle mechanical support, they are not appropriate to predict late right heart failure, because the hemodynamic conditions are completely modified. RV function is particularly affected by the LVAD speed by changing RV preload and afterload as well as the position of the interventricular septum. All these parameters are susceptible of echocardiographic or hemodynamic optimizations that are gaining interest in the setting of the so-called postoperative RAMP test. Despite a growing body of evidences and number of publications on this topic, no guidelines have drawn indications on how set-up correctly the speed and medical therapy during this test. There have been no studies focusing on the combined effect of right heart function, left ventricular preload, mean arterial blood pressure and pump speed on the incidence of late right ventricular failure.
In the present study, we proposed a new HEMODYNAMIC INDEX  formulated using data obtained after from postoperative right-sided heart catheterization and integrates preload, afterload and pump speed. Finally, we determined its relationship with late RVF after LVAD implantation.