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The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.

Right heart failure after left ventricular assist device implantation – from prediction to action

  • Sameer K. Singh
    Affiliations
    Department of Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Irving Medical Center. New York, New York
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  • Koji Takeda
    Correspondence
    Reprint requests: Koji Takeda, MD, PhD, Columbia University Irving Medical Center, Department of Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, 177 Fort Washington Avenue, New York, NY 10032.
    Affiliations
    Department of Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Irving Medical Center. New York, New York
    Search for articles by this author
      In this issue of the Journal, Read and colleagues
      • Read JM
      • Azih NI
      • Peters CJ
      • et al.
      Hemodynamic reserve predicts early right heart failure after LVAD implantation.
      report the use of peak stroke volume index (SVI) during pre-procedure vasodilatory testing as a predictor of early right heart failure (RHF) after left ventricular assist device (LVAD) implantation. They retrospectively examine 70 patients from 3 institutions who underwent pre-implant nitroprusside vasodilator testing. Indications for pre-operative vasodilator testing were elevated pulmonary vascular resistance, pulmonary arterial wedge pressure, or systolic pulmonary artery pressure. Among this cohort, 39% of patients developed acute RHF after LVAD implantation, as defined by the recent consensus statement by the Mechanical Circulatory Support Academic Research Consortium.
      • Kormos RL
      • Antonides CFJ
      • Goldstein DJ
      • et al.
      Updated definitions of adverse events for trials and registries of mechanical circulatory support: A consensus statement of the mechanical circulatory support academic research consortium.
      Moreover, 20% of patients required right ventricular assist device (RVAD) support. Multivariable regression analysis demonstrated that a decreased peak SVI was significantly associated with the development of early RHF. ROC curve revealed an area under the curve of 0.78 with an optimal cut point of 22.1 mL/m2 while demonstrating a 16% risk increment of early RHF per 1 ml/m2 decrease in SVI. This interaction was also demonstrated in sub-group analysis in patients who underwent HeartMate3 implantation and those with RHF that did not require RVAD. The authors also prospectively examined 10 consecutive patients who underwent vasodilator testing prior to LVAD implantation and found that peak SVI was a consistent predictor of early postoperative RHF.
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