Right ventricular failure (RVF) is a serious and common complication in left ventricular assist device (LVAD) recipients that remains difficult to predict. A novel approach to patient consent may enhance your options in the operating room (OR) upon right ventricular (RV) visualization.
RVF is a frequent complication following LVAD implantation, occurring in 10% to 40% of patients1. Patients who develop RVF have reduced survival and progression to transplant and worse outcomes thereafter, including longer ICU stays, more transfusions, use of inotropes and need for right ventricular assist devices (RVADs)2. Adding an RVAD before orthotopic heart transplantation is associated with worse post-transplant outcomes and increased mortality3.
In an effort to reduce the incidence of RVF post-LVAD implant and improve outcomes, numerous approaches to predict RVF in LVAD recipients have been implemented; however, an accurate method of predicting RVF remains elusive.
Optimizing Treatment Plans in the OR
Given the challenges of predicting RVF prior to LVAD implant, making the determination whether a patient requires an LVAD or the SynCardia temporary Total Artificial Heart (TAH) may be optimized while in the OR. Once the chest is open, the degree of stress on the right ventricle may be more accurately assessed.
Utilizing this approach would require obtaining patient consent for LVAD and TAH implantation in advance, as well as having both devices on the shelf and ready for use in the OR. Once the chest is open and a more accurate assessment of the patient’s RV is performed, having both options available will enable the implanting surgeon to make the best decision possible for the patient. It will also allow flexibility to change the initial treatment plan, if necessary.
In addition, having the TAH on hand for all major cardiac surgeries, not just LVAD implants, may provide a critical safety net for unexpected emergencies or major complications that may lead to biventricular failure in the OR.
1Lampert B.C., Teuteberg J.J. (2015) Right ventricular failure after left ventricular assist devices. J Heart Lung Transplant 34:1123–1130
2Kalogeropoulos AP, Al-Anbari R, Pekarek A, et al. The Right Ventricular Function After Left Ventricular Assist Device (RVF-LVAD) study: rationale and preliminary results. European Heart Journal – Cardiovascular Imaging. 2015;17(4):429-437. doi:10.1093/ehjci/jev162.
3Taghavi S, Jayarajan SN, Komaroff E, Mangi AA. Right ventricular assist device results in worse post-transplant survival. The Journal of Heart and Lung Transplantation. 2016;35(2):236-241. doi:10.1016/j.healun.2015.10.018.