Introduction:
Right ventricular failure (RVF) is a common complication following LVAD implantation and a significant driver of post-LVAD mortality. dP/dt
max
, the maximum rate of rise in ventricular pressure, is a validated hemodynamic parameter of ventricular contractility that, when indexed to CVP, accounts for loading conditions. This parameter has not, however, been studied in the context of post-LVAD RVF. We therefore evaluated the relationship between dP/dt
max
/CVP and post-LVAD RVF in a cohort of LVAD recipients at Stanford.
Methods:
We conducted a retrospective, single-center analysis of patients who underwent continuous-flow LVAD implant at Stanford between January 2010 and June 2019. Preoperative RV dP/dt
max
/CVP values were extracted from right heart catheterization (RHC) reports. For cases in which dP/dt
max
/CVP was not reported, preoperative RA and RV pressure tracings were utilized to manually calculate the index. We then performed unpaired t-tests to evaluate for the presence of associations between dP/dt
max
/CVP and early post-LVAD RVF, defined as the prolonged (>7 days) requirement for inotropic or pulmonary vasodilator therapy or the need for RVAD support, and between dP/dt
max
/CVP and severe post-LVAD RVF, defined only by the requirement for RVAD support.
Results:
This cohort included 202 LVAD recipients who had available preoperative RHC data. Of these, 14.4% (n = 29) required an RVAD and 50.5% (n = 102) experienced early post-LVAD RVF. Mean values of dP/dt
max
/CVP amongst patients with and without early post-LVAD RV failure were 94.9 ± 128.5 s
-1
and 105.6 ± 125.5 s
-1
(p = 0.56), respectively, while mean values of dP/dt
max
/CVP amongst those who did and did not require an RVAD were 53.2± 42.0 s
-1
and 108.2 ± 129.5 s
-1
(p = 4.2 х 10
-5
), respectively.
Conclusion:
In continuous-flow LVAD recipients, low preoperative RV dP/dt
max
/CVP is strongly associated with severe post-LVAD RVF requiring RVAD support but not early post-LVAD RVF more generally.
Weaning from ventricular assist device support after recovery from left ventricular failure with or without secondary right ventricular failure
