INTRODUCTION
Mechanical ventricular assistance systems are increasingly acquiring a
pivotal role in the treatment of heart failure refractory to medical
therapy [1]. The technological evolution has led to the development
of remarkably reliable systems, also suitable for use as destination
therapy in those who are not candidates for heart transplantation.
Although these systems offer increasingly excellent safety profiles,
lower risks of device failure, and improved blood compatibility, the
prospect of left ventricular system supporting life long term is
dependent on right ventricular (RV) function. Right ventricular failure
(RVF) is a frequent and severe event that increases perioperative
mortality after Left Ventricle Assist Device (LVAD) implantation.
Previous reports revealed that the prevalence of RVF after LVAD
implantation ranged from 10% to 40% [2-3-4]. To date, many studies
have reported hemodynamic predictors of RVF including elevated central
venous pressure (CVP), CVP/Pulmonary Capillary Wedge Pressure (PCWP)
ratio, Right Ventricular Stroke Work Index (RVSWI), and Pulmonary Artery
Pulsatility index (PAPi) [5-6-7]. Although these scores have
possible utility in identifying preoperative features that increase the
risk of right heart failure during left ventricle mechanical support,
they are not appropriate to predict late right heart failure, because
the hemodynamic conditions are completely modified. RV function is
particularly affected by the LVAD speed by changing RV preload and
afterload as well as the position of the interventricular septum. All
these parameters are susceptible of echocardiographic or hemodynamic
optimizations that are gaining interest in the setting of the so-called
postoperative RAMP test. Despite a growing body of evidences and number
of publications on this topic, no guidelines have drawn indications on
how set-up correctly the speed and medical therapy during this test.
There have been no studies focusing on the combined effect of right
heart function, left ventricular preload, mean arterial blood pressure
and pump speed on the incidence of late right ventricular failure.
In the present study, we proposed a new HEMODYNAMIC
INDEX formulated using data obtained after from postoperative
right-sided heart catheterization and integrates preload, afterload and
pump speed. Finally, we determined its relationship with late RVF after
LVAD implantation.