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Heart, Lung and Circulation

Predicting Right Ventricular Failure after Left Ventricular Assist Device Implantation: Are We There Yet?

Published:August 16, 2022DOI:https://doi.org/10.1016/j.hlc.2022.06.673
      Right ventricular failure (RVF) is the Achilles’ heel of durable left ventricular assist device (LVAD) therapy and causes significant morbidity and mortality in 9–42% of patients following LVAD implantation [
      • Turner K.R.
      Right ventricular failure after left ventricular assist device placement—the beginning of the end or just another challenge?.
      ]. Consequently, identifying patients at increased risk for RVF prior to implantation is paramount to guiding patient candidacy, ensuring preoperative right ventricular (RV) optimisation, and individualising postoperative management [
      • Alfirevic A.
      • Makarova N.
      • Kelava M.
      • Sale S.
      • Soltesz E.
      • Duncan A.E.
      Predicting right ventricular failure after LVAD implantation: role of tricuspid valve annulus displacement.
      ]. Current available RVF predictors are imperfect. Clinical scoring models, such as the Michigan Score, have been the mainstay of risk stratification [
      • Kalogeropoulos A.P.
      • Kelkar A.
      • Weinberger J.F.
      • et al.
      Validation of clinical scores for right ventricular failure prediction after implantation of continuous-flow left ventricular assist devices.
      ]; however, by utilising preoperative clinical stability and biochemical markers of end-organ function as surrogates for RV function, the Michigan Score cannot provide an actual picture of RV health and thereby misses cases of equivocal or subclinical RV dysfunction [
      • Peters A.E.
      • Smith L.A.
      • Ababio P.
      • et al.
      Comparative analysis of established risk scores and novel hemodynamic metrics in predicting right ventricular failure in left ventricular assist device patients.
      ]. Haemodynamic metrics of RV performance, such as central venous pressure (CVP), CVP/pulmonary capillary wedge pressure (PCWP), and right ventricular stroke work index (RVSWI) are also available. However, these are complex and heavily influenced by left ventricular function and atrioventricular valvular pathology [
      • Hayek S.
      • Sims D.B.
      • Markham D.W.
      • Butler J.
      • Kalogeropoulos A.P.
      Assessment of right ventricular function in left ventricular assist device candidates.
      ]. There is an urgency to discover better assessors of RV function and develop models that better predict RVF in LVAD recipients.

      Keywords

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