Can perioperative right-ventricular support avoid postoperative right-heart failure in patients with biventricular dysfunction undergoing left-ventricular assist device implantation?

Objectives Depending on the pre-existing condition of the right ventricle (RV), left-ventricular assist device (LVAD) implantation may have a detrimental effect on RV function, subsequently leading to right-heart failure. This study details our experience with perioperative mechanical RV support in patients with biventricular impairment but primarily planned for isolated LVAD implantation. Design retrospective study. Setting two center study, university hospital. Participants This study included LVAD recipients with preoperative biventricular impairment who received an additional RVAD after a failed weaning attempt from CPB due to acute RV failure. Interventions Outcomes of 25 patients after LVAD and unplanned temporary RVAD implantation were analyzed. Measurements and Main Results All patients suffered preoperatively from significant RV impairment (tricuspid annular plane systolic excursion (TAPSE): 10.2±26.3 mm, right atrium pressure: 17.9±10.4 mmHg) and pulmonary hypertension (pulmonary artery pressure: 54.8±25.7 mmHg). In 15 patients, additional tricuspid valve annuloplasty was performed. Mean duration of temporary RVAD support was 11.1±7.2 days. In 23 patients (92%), the RVAD could be successfully removed. None of the patients developed RV failure after RVAD removal. Hospital survival and 1-year survival rate of the study group were 68% and 56% respectively. Conclusions The results of perioperative RVAD support in LVAD recipients with biventricular dysfunction are encouraging. Temporary RVAD allows an already compromised RV to become attuned to the hemodynamic conditions after LVAD implantation. This strategy allows patients with preoperatively impaired RV function a high likelihood to be permanently on LVAD support only.