Predicted Risk of Right Ventricular Failure After Minimally Invasive Left Ventricular Assist Device Implantation
Madonna Lee, Asia McDavid, Bassam Shukrallah, Ahmet Kilic, Peter Lee, Ayesha Hasan, Hamdy Elsayed-Awad, Michael Essandoh, Bryan Whitson.
The Ohio State University - Wexner Medical Center, Columbus, OH, USA.
BACKGROUND: Currently, risk scores exist which predict post-operative right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation. However, a minimally invasive approach has shown to improve survival and decrease morbidity. Thus, it is unclear whether current RVF predictive models accurately risk-stratify patients who undergo LVAD placement through a minimally invasive approach. METHODS: We retrospectively analyzed our patients from April 30, 2016 until December 21, 2017. We had a total of 11 patients who had a minimally invasive LVAD. We collected demographics, and pre-operative risk factors such as pre-operative ventilation, central venous pressure/pulmonary capillary wedge pressure ratio >0.63, BUN>39 mg/dL (Kormos et al, 2010). We also used the “Right Ventricular Failure Risk Score” (RVFRS) with vasopressor requirement, aspartate aminotransferase >80 IU/l, bilirubin >2.0 mg/dl, and creatinine> 2.3 mg/dl (Matthews et al, 2008).
RESULTS: The average RVFRS was 4.05, with being on vasopressors as the most significant risk factor. The overall likelihood ratio of RVF was 2.8. However, post-implantation, only one patient (9.09%) had severe/severe-acute RVF as defined by INTERMACS. Yet, this patient did not have the highest RVFRS. 8 out of the 11 patients (72.7%) had elevated TB >2.0 and CVP>16 on the first post-operative day, but resolved post-operative day two with diuresis. 2 out of 11 patients were on the ventilator pre-operatively, but these patients did not develop post-implantation RVF. No patients had pre-operative elevated serum creatinine >2.0 or BUN> 39 mg/dL.
CONCLUSIONS: Although there are risk scores looking at nonhemodynamic parameters as a predictor for RVF after LVAD placement, these do not appear to be consistent for patients who undergo a minimally invasive approach. In order to determine a better risk-stratification system, more analysis needs to be done specifically looking at echocardiographic risk factors for RVF post-LVAD implantation in patients who have undergone a minimally invasive approach.
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