Details

Autor(en) / Beteiligte

• Potapov, Evgenij V., MD
• Stepanenko, Alexander, MD
• Dandel, Michael, MD, PhD
• Kukucka, Marian, MD
• Lehmkuhl, Hans B., MD
• Weng, Yuguo, MD, PhD
• Hennig, Felix, MD
• Krabatsch, Thomas, MD, PhD
• Hetzer, Roland, MD, PhD

Titel

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

Ist Teil von

• The Journal of heart and lung transplantation, 2008-12, Vol.27 (12), p.1275-1281

Ort / Verlag

New York, NY: Elsevier Inc

Erscheinungsjahr

2008

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• 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 <30%), right atrial dimension (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 <liters/min/m2 ; inotropic support score >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 <0.6, RV failure occurred in 7% of patients, as compared with 50% for patients with a ratio ≥0.6 ( p = 0.013). Among patients with TI Grade III or IV, 75% developed RV failure as compared with 12% in patients with TI Grade I or II ( p = 0.054). The odds ratio for RV failure after LVAD implantation for TI Grade III or IV was 4.7 ( p = 0.012). Conclusions Pre-operative evaluation of tricuspid incompetence and RV geometry may help to select patients who would benefit from biventricular support.