Vnitr Lek 2010, 56(1):30-36

Right ventricular dysfunction after left ventricular assist device implantation

H. Říha^1,4,*, I. Netuka^2,4, T. Kotulák¹, J. Malý^2,4, M. Pinďák¹, P. Kellovský¹, F. Kopáč¹, D. Hodr¹, O. Szárszoi^2,4, J. Kettner³, H. Al-Hiti², Z. Dorazilová³, T. Marek³, I. Skalský², J. Pirk^2,4

¹ Klinika anesteziologie a resuscitace, Kardiocentrum IKEM Praha, přednosta prim. MUDr. Tomáš Kotulák

² Klinika kardiovaskulární chirurgie, Kardiocentrum IKEM Praha, přednosta prof. MUDr. Jan Pirk, DrSc.

³ Klinika kardiologie, Kardiocentrum IKEM Praha, přednosta prof. MUDr. Josef Kautzner, CSc.

⁴ Centrum výzkumu chorob srdce a cév IKEM Praha, vedoucí projektu prof. MUDr. Bohuslav Ošťádal, DrSc.

Objective:
The frequency of long-term left ventricular assist device (LVAD) implantation is increasing. Acute right ventricular dysfunction or right ventricular failure after LVAD implantation has important influence on morbidity and mortality. The aim of our study was to assess the management of right ventricular dysfunction after LVAD implantation.

Methods:
The study group comprised 21 patients with implanted HeartMate II® LVAD since December, 2006 to April, 2009. We evaluated in retrospective fashion baseline parameters of cardiovascular and other organ systems before LVAD implantation, applied pharmacological and mechanical support for the right ventricle, and important clinical outcomes to the end of June, 2009.

Results:
LVAD was implanted in 18 men and 3 women with mean age of 48.7 ± 11.2 years. The most frequent diagnosis was dilatational cardiomyopathy (9 patients; 42.9%), and the most frequent indication for implantation was bridge-to-transplantation (19 patients; 90.4%). Pharmacological support of the right ventricle after LVAD implantation comprised dobutamine (21 patients; 100%), milrinone (21 patients; 100%), isoproterenol (1 patient; 4.8%), and levosimendan (5 patients; 23.8%). In 2 (9.5%) cases there was a need for repeated application of levosimendan during postoperative course. Inhalational nitric oxide was used in 14 (66.7%) patients. Despite extensive pharmacological support, 3 (14.3%) patients needed right ventricular assist device (RVAD) implantation. Most patients (9; 42.8%) survived to heart transplantation; in one (4.8%) case LVAD was successfuly explanted; 6 (28.6%) patients is living with LVAD; 5 (23.8%) patients died during LVAD support.

Conclusion:
After LVAD implantation there is a need for aggressive pharmacological, and in some cases mechanical, support of the right ventricular function to provide adequate blood flow to LVAD in order to minimize morbidity and mortality.

Keywords: mechanical circulatory support; right ventricular dysfunction; levosimendan; nitric oxide

Received: August 13, 2009; Accepted: October 21, 2009; Published: January 1, 2010  Show citation