Right Atrial Pressure Waveform Predicts Right Ventricular Failure After Left Ventricular Assist Device Implantation

Abstract

Background: Right ventricular failure (RVF) is one of the major adverse events after left ventricular assist device (LVAD) implantation. Right ventricle (RV) distensibility plays a key role in the preload reserve capability and in RV ejection through the Frank-Starling mechanism. However, there are no studies focusing on the relationship between RVF and RV distensibility.

Methods: Between 2013 and 2017, 115 consecutive patients underwent continuous-flow LVAD implantation at Osaka University Hospital. Of these, 71 who recorded preoperative right atrial pressure waveform were included. We assessed RV distensibility and the incidence and risk factors for RVF, which was defined as the requirement for a right ventricular assist device or 14 or more consecutive days of inotropic support required postoperatively, or both. A distensible RV was interpreted if the right atrial pressure waveform showed a dominant "Y" descent that was equal to or deeper than the "X" descent.

Results: Thirty-two patients (45%) had RVF after LVAD implantation. Among the patients with RVF, 4 required right ventricular assist device support and all of them had a less distensible RV. Multivariate analysis revealed that a less distensible RV (odds ratio 10.5, 95% confidence interval, 1.75 to 63.5, P = .003) and an elevated level of central venous pressure/pulmonary capillary wedge pressure (odds ratio 2.02, 95% confidence interval, 1.20 to 3.40, P = .002) were independent risk factors for RVF after LVAD implantation.

Conclusions: Less distensible RV and elevated central venous pressure/pulmonary capillary wedge pressure level were significant risks for RVF after LVAD implantation. This result suggested that analysis of not only the hemodynamic numbers but also the pattern of waveforms are important to assess risk for RVF in LVAD candidates.