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Predictors of right ventricular failure after implantation of left ventricular assist devices

Predictors of right ventricular failure after implantation of left ventricular assist devices Right ventricular failure, Mechanical circulatory support, Ventricular assist device, Risk factors Congratulations to Boegershausen et al. [1] on their study. As the authors have noted, the incidence of right ventricular failure (RVF) development after implantation of left ventricular assist devices (LVADs), which is the most important treatment option for advanced stage heart failure, is not very low. In various series, this ratio is up to 50% [2–4]. As can be seen, RVF development rates are extremely high. Even more important subject is the increased mortality rates when RVF develops after LVAD. Therefore, determining the RVF predictors after LVAD is frequently discussed as an important topic today. But, in the literature, many different parameters have been emphasized with regard to the predictive factors for the development of RVF after LVAD. For example, in this study, Boegershausen et al. report that only the basal longitudinal systolic strain of the right ventricular (RV) free wall (PSLSbasal) and the central venous pressure are predictive factors for RVF. Similarly, another study of 4428 patients reported that high central venous pressure and low right ventricular stroke work index were predictive factors for RVF after LVAD [4]. But, in the same study, unlike the study by Boegershausen et al., they reported that international normalized ratio, N-terminal pro-b-type natriuretic peptide, moderate-to-severe right ventricular dysfunction, increased right ventricular/left ventricular ratio and preprocedural ventilator dependence were also predictive factors for RVF after LVAD implantation. Another study [5] reported that parameters such as increased pulmonary artery pressure, increased right atrial pressure, decreased stroke volume, preoperative severe tricuspid regurgitation and renal replacement therapy were risk factors for RFV, unlike the study by Boegershausen et al. It is, of course, it is possible to increase these examples. However, it is clear that there is no single predictive factor for the development of RVF after LVAD. Another issue that we want to mention is that the main treatments applied by Boegershausen et al. for RVF after LVAD implantation are vasodilator inhalation, prolongation of inotropic treatment and right-sided extracorporeal membrane oxygenation. However, other ventricular support systems, such as a Levitronix CentriMag ventricular assist device for the right side, have never been used. How do authors explain the reason for this? We believe that sharing the authors’ ideas on this subject will add value to their study. REFERENCES [1] Boegershausen N , Zayat R , Aljalloud A , Musetti G , Goetzenich A , Tewarie L et al. Risk factors for the development of right ventricular failure after left ventricular assist device implantation-a single-centre retrospective with focus on deformation imaging . Eur J Cardiothorac Surg 2017 ; 52 : 1069 – 76 . Google Scholar CrossRef Search ADS PubMed [2] McIlvennan CK , Magid KH , Ambardekar AV , Thompson JS , Matlock DD , Allen LA. Clinical outcomes after continuous-flow left ventricular assist device: a systematic review . Circ Heart Fail 2014 ; 7 : 1003 – 13 . Google Scholar CrossRef Search ADS PubMed [3] Lampert BC , Teuteberg JJ. Right ventricular failure after left ventricular assist devices . J Heart Lung Transplant 2015 ; 34 : 1123 – 30 . Google Scholar CrossRef Search ADS PubMed [4] Bellavia D , Iacovoni A , Scardulla C , Moja L , Pilato M , Kushwaha SS et al. Prediction of right ventricular failure after ventricular assist device implant: systematic review and meta-analysis of observational studies . Eur J Heart Fail 2017 ; 19 : 926 – 46 . Google Scholar CrossRef Search ADS PubMed [5] Kiernan MS , Grandin EW , Brinkley M Jr , Kapur NK , Pham DT , Ruthazer R et al. Early right ventricular assist device use in patients undergoing continuous-flow left ventricular assist device implantation: incidence and risk factors from the interagency registry for mechanically assisted circulatory support . Circ Heart Fail 2017 ; 10 : e003863 . Google Scholar CrossRef Search ADS PubMed © The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Cardio-Thoracic Surgery Oxford University Press

Predictors of right ventricular failure after implantation of left ventricular assist devices

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References (6)

Publisher
Oxford University Press
Copyright
© The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
ISSN
1010-7940
eISSN
1873-734X
DOI
10.1093/ejcts/ezy012
Publisher site
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Abstract

Right ventricular failure, Mechanical circulatory support, Ventricular assist device, Risk factors Congratulations to Boegershausen et al. [1] on their study. As the authors have noted, the incidence of right ventricular failure (RVF) development after implantation of left ventricular assist devices (LVADs), which is the most important treatment option for advanced stage heart failure, is not very low. In various series, this ratio is up to 50% [2–4]. As can be seen, RVF development rates are extremely high. Even more important subject is the increased mortality rates when RVF develops after LVAD. Therefore, determining the RVF predictors after LVAD is frequently discussed as an important topic today. But, in the literature, many different parameters have been emphasized with regard to the predictive factors for the development of RVF after LVAD. For example, in this study, Boegershausen et al. report that only the basal longitudinal systolic strain of the right ventricular (RV) free wall (PSLSbasal) and the central venous pressure are predictive factors for RVF. Similarly, another study of 4428 patients reported that high central venous pressure and low right ventricular stroke work index were predictive factors for RVF after LVAD [4]. But, in the same study, unlike the study by Boegershausen et al., they reported that international normalized ratio, N-terminal pro-b-type natriuretic peptide, moderate-to-severe right ventricular dysfunction, increased right ventricular/left ventricular ratio and preprocedural ventilator dependence were also predictive factors for RVF after LVAD implantation. Another study [5] reported that parameters such as increased pulmonary artery pressure, increased right atrial pressure, decreased stroke volume, preoperative severe tricuspid regurgitation and renal replacement therapy were risk factors for RFV, unlike the study by Boegershausen et al. It is, of course, it is possible to increase these examples. However, it is clear that there is no single predictive factor for the development of RVF after LVAD. Another issue that we want to mention is that the main treatments applied by Boegershausen et al. for RVF after LVAD implantation are vasodilator inhalation, prolongation of inotropic treatment and right-sided extracorporeal membrane oxygenation. However, other ventricular support systems, such as a Levitronix CentriMag ventricular assist device for the right side, have never been used. How do authors explain the reason for this? We believe that sharing the authors’ ideas on this subject will add value to their study. REFERENCES [1] Boegershausen N , Zayat R , Aljalloud A , Musetti G , Goetzenich A , Tewarie L et al. Risk factors for the development of right ventricular failure after left ventricular assist device implantation-a single-centre retrospective with focus on deformation imaging . Eur J Cardiothorac Surg 2017 ; 52 : 1069 – 76 . Google Scholar CrossRef Search ADS PubMed [2] McIlvennan CK , Magid KH , Ambardekar AV , Thompson JS , Matlock DD , Allen LA. Clinical outcomes after continuous-flow left ventricular assist device: a systematic review . Circ Heart Fail 2014 ; 7 : 1003 – 13 . Google Scholar CrossRef Search ADS PubMed [3] Lampert BC , Teuteberg JJ. Right ventricular failure after left ventricular assist devices . J Heart Lung Transplant 2015 ; 34 : 1123 – 30 . Google Scholar CrossRef Search ADS PubMed [4] Bellavia D , Iacovoni A , Scardulla C , Moja L , Pilato M , Kushwaha SS et al. Prediction of right ventricular failure after ventricular assist device implant: systematic review and meta-analysis of observational studies . Eur J Heart Fail 2017 ; 19 : 926 – 46 . Google Scholar CrossRef Search ADS PubMed [5] Kiernan MS , Grandin EW , Brinkley M Jr , Kapur NK , Pham DT , Ruthazer R et al. Early right ventricular assist device use in patients undergoing continuous-flow left ventricular assist device implantation: incidence and risk factors from the interagency registry for mechanically assisted circulatory support . Circ Heart Fail 2017 ; 10 : e003863 . Google Scholar CrossRef Search ADS PubMed © The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

Journal

European Journal of Cardio-Thoracic Surgery – Oxford University Press

Published: Feb 6, 2018

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