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.