Preoperative Diuretic Resistance and Risk of Right Heart Failure (RHF) Post-LVAD Implantation

Purpose Early, severe RHF remains prevalent in up to 30% of patients undergoing LVAD surgery. Our aim was to investigate the correlation between baseline diuretic requirement, diuretic efficiency and the risk of post-operative RHF. Methods 24-hour diuretic dose and urine output were collected within 72 hours of LVAD surgery. Total daily diuretic dose was grouped into low (≤ 80mg), medium (81mg-479mg) and high (≥ 480mg) dose groups. The primary outcome variable was early, severe RHF, defined as the composite of RVAD implant, prolonged inotropic use (≥ 14 days) or death during index stay. Secondary outcomes included the primary component variables, post-implant ICU and hospital lengths of stay (LOS), and 12-month mortality. Results 147 patients were included: mean age 57.1 ± 11.1 years, 17.0% were female. Average 24h diuretic across the population was 371.0 ± 433.7 mg IV furosemide equivalent, while average diuretic efficiency was 846.9 ± 1099.7 mL per 40mg furosemide. Serum creatinine and BUN were highest in the high dose group, while sodium was lowest in this group (Table). There was a graded risk for RHF across dosing groups, with the high dose group having the highest risk of RHF (62%). No patients in the low dose group required an RVAD, compared to 14% in the high dose group (Table). Prolonged inotrope utilization was also higher in the medium and high dose groups. Average ICU and post-operative LOS were shortest in the low dose group. Utilizing tertiles of diuretic efficiency as the exposure variable resulted in analogous findings. 12-month survival for patients in the lose dose group was 90.2%, compared to 80.4% in the medium, and 86% in the high dose groups (p=0.39). Conclusion Higher diuretic requirement suggests clinically significant right ventricular dysfunction and can assist in preoperative risk profiling of RHF in LVAD candidates.