Tricuspid Incompetence and Geometry of the Right Ventricle as Predictors of Right Ventricular Function After Implantation of a Left Ventricular Assist Device

Background Implantation of a left ventricular assist device (LVAD) is an established treatment for end-stage heart failure. Right ventricular (RV) dysfunction develops in 20% to 50% of patients after LVAD implantation, leading to prolonged ICU stay and elevated mortality. However, the prediction of RV failure remains difficult. Methods The pre-operative echocardiographic parameters, tricuspid incompetence (TI), RV end-diastolic diameter (cut-off >35 mm), RV ejection fraction (cut-off 50 mm) and short/long axis ratio (cut-off >0.6), were analyzed retrospectively in 54 patients. Patients were divided into two groups. One group consisted of patients with RV failure ( n = 9), as defined by the presence of two of the following criteria in the first 48 hours after surgery: mean arterial pressure ≤55 mm Hg; central venous pressure ≥16 mm Hg; mixed venous saturation ≤55%; cardiac index 20 units; or need for an RVAD. The other patients comprised the non–RV-failure group ( n = 45). Results The RV failure group had a significantly higher short/long axis ratio of the RV (0.63 vs 0.52, p = 0.03; odds ratio 4.4, p = 0.011). For patients with a short/long axis ratio of the RV of