Right ventricular failure after implantation of a continuous-flow left ventricular assist device: early haemodynamic predictors †

OBJECTIVES: Right ventricular failure (RVF) is a significant complication after implantation of a left ventricular assist device. We aimed to identify haemodynamic changes in the early postoperative phase that predicted subsequent development of RVF in a cohort of HeartMate II (HMII) implanted patients. METHODS: This was a single-centre observational study of consecutive placement of HMII devices at Rigshospitalet, Copenhagen. Preoperative data (right heart catheterization, biochemistry and clinical status) and postoperative readings from the first 72 h after implantation (haemodynamics, inotropic and vasoactive therapy) were included in the analysis. The data set was examined for significant differences between patients who developed RVF (RVF group, n= 11)—defined as need for inotropic or vasodilator therapy >14 days, nitric oxide therapy ≥48 h or right ventricular assist device therapy—and those who did not (non-RVF group, n= 22). RESULTS: Preoperative right heart catheterization data were similar in the two groups. Immediately after HMII implantation, the increase in cardiac index (CI) was significantly larger in the non-RVF than in the RVF group (0.96 ± 0.8 vs 0.2 ± 0.5 L/min, respectively; P= 0.018), whereas right ventricular stroke work index (RVSWI) decreased significantly more in the RVF group (−4.3 ± 2.0 vs −0.9 ± 2.0 g m/m 2 ; P< 0.001). These differences were present in spite of the RVF group receiving larger doses of catecholaminergic agents (P= 0.034). Over the ensuing 72 h, the CI of the RVF group gradually approached that of the non-RVF group; concurrently, however, the differences in inotropic therapy were further enhanced. Pump settings were similar in the two groups. CONCLUSIONS: The haemodynamic alterations characterizing RVF were present already immediately after HMII implantation. RVF development was not related to pump flow and settings.