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. 2024 Jul;168(1):133-144.e5.
doi: 10.1016/j.jtcvs.2023.07.019. Epub 2023 Jul 24.

Preoperative passive venous pressure-driven cardiac function determines left ventricular assist device outcomes

Paul C Tang  1 , Jessica Millar  2 , Pierre Emmanuel Noly  3 , Hüseyin Sicim  4 , Donald S Likosky  4 , Min Zhang  5 , Francis D Pagani  4 ; Michigan Congestive Heart Failure Investigators
Collaborators, Affiliations

Preoperative passive venous pressure-driven cardiac function determines left ventricular assist device outcomes

Paul C Tang et al. J Thorac Cardiovasc Surg. 2024 Jul.

Abstract

Background: Right heart output in heart failure can be compensated through increasing systemic venous pressure. We determined whether the magnitude of this "passive cardiac output" can predict LVAD outcomes.

Methods: This was a retrospective review of 383 patients who received a continuous-flow LVAD at the University of Michigan between 2012 and 2021. Pre-LVAD cardiac output driven by venous pressure was determined by dividing right atrial pressure by mean pulmonary artery pressure, multiplied by total cardiac output. Normalization to body surface area led to the passive cardiac index (PasCI). The Youden J statistic was used to identify the PasCI threshold, which predicted LVAD death by 2 years.

Results: Increased preoperative PasCI was associated with reduced survival (hazard ratio [HR], 2.27; P < .01), and increased risk of right ventricular failure (RVF) (HR, 3.46; P = .04). Youden analysis showed that a preoperative PasCI ≥0.5 (n = 226) predicted LVAD death (P = .10). Patients with PasCI ≥0.5 had poorer survival (P = .02), with a trend toward more heart failure readmission days (mean, 45.09 ± 67.64 vs 35.13 ± 45.02 days; P = .084) and increased gastrointestinal bleeding (29.2% vs 20.4%; P = .052). Additionally, of the 97 patients who experienced readmissions for heart failure, those with pre-LVAD implantation PasCI ≥0.5 were more likely to have more than 1 readmission (P = .05).

Conclusions: Although right heart output can be augmented by raising venous pressure, this negatively impacts end-organ function and increases heart failure readmission days. Patients with a pre-LVAD PasCI ≥0.5 have worse post-LVAD survival and increased RVF. Using the PasCI metric in isolation or incorporated into a predictive model may improve the management of LVAD candidates with RV dysfunction.

Keywords: Fontan; Youden J statistic; clinical outcomes; echocardiography; left ventricular assist device; right ventricular assist device; right ventricular failure.

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Conflict of interest statement

Conflict of Interest Statement

The authors reported no conflicts of interest.

The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Survival for the entire study population and the HeartMate 3 (HM3) population according to the PasCI (passive cardiac index). A, Overall survival for the total study population with corresponding 95% confidence bands. B, Survival for the HM3 population with corresponding 95% confidence bands. LVAD, Left ventricular assist device.
FIGURE 2.
FIGURE 2.
Graphical abstract. LVAD, Left ventricular assist device; RV, right ventricle.
See this image and copyright information in PMC

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