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DOI: 10.1055/s-0034-1367362
Effect of long-term afterload reduction on right ventricular function in patients undergoing left ventricular assist device implantation: Resurrection of the right?
Introduction: The HVAD is a miniaturized ventricular assist device (VAD) which is routinely used for left sided support in patient with end stage heart failure as a bridge to transplant. Amongst the reasons for implantation are left ventricular failure as well as elevated pulmonary vascular pressure and resistance. Many patients undergoing LVAD implantation have impaired right ventriclular (RV) function and there is reason to suspect at least a partial longer term RV improvement. As little is known about the long-term effect of LVADs on RV function, we sought to assess echocardiographic parameters with a special emphasis on changes in RV function in patients on VADs.
Methods: Preoperative and 6-month-postoperative echocardiographic data of 40 patients undergoing HVAD implantation in our institution between 2007 and 2012 were retrospectively evaluated. Right and left ventricular function was assessed using tricuspid annular plane systolic excursion (TAPSE) and left ventricular ejection fraction (EF) / fractional shortening (FS) respectively. Estimated pulmonary artery pressure (PAP) was used for indirect assessment of pulmonary vascular resistance.
Results: 6-month mortality rate was 15% (6 patients). 12.5% (5 patients) developed immediate postoperative right ventricular failure requiring mechanical support. All echocardiographic results are presented in Table 1.
| Preoperative | 6 month postoperative | P value | |
|---|---|---|---|
| TAPSE (cm) | 1.34 | 1.17 | 0.110 |
| Estimated PAP (mmHg) | 38.10 | 19.90 | <0.001 |
| LV Ejection fraction (%) | 21.67 | 31.50 | 0.051 |
| LV Fraction shortening (%) | 12.15 | 18.35 | 0.001 |
| IVSD (mm) | 19.14 | 19.48 | 0.599 |
| LVDD (mm) | 70.69 | 59.41 | 0.001 |
| LVSD (mm) | 63.03 | 49.06 | <0.001 |
| LVPWD (mm) | 8.11 | 8.98 | 0.062 |
| LVPWS (mm) | 11.61 | 13.73 | 0.002 |
Conclusion: HVAD support in advanced heart failure significantly improves LV function indicating successful LV remodeling. However and surprisingly, despite reduced PAP, HVAD LVAD support is not associated with improved RV function 6 months after implantation. Further observations are necessary to evaluate long-term impact of HVAD LVAD on RV function.