Long-term survival, right ventricle function and organ complications in patients with left ventricular assist device support and suboptimal right ventricle function before implantation

Introduction Circulatory support with the left ventricular assist device (LVAD) is a final therapeutic method for severe heart failure, particularly when a heart transplantation is not possible. One of the main contraindications to LVAD implantation is the right ventricle (RV) failure, which is often not a primary disorder but an effect of the left ventricle failure. Purpose Assessment of long-term survival, RV function and presence of organ complications in patients with LVADs and suboptimal RV function before implantation. Methods 73 consecutive patients with LVADs implanted in years 2013-2024 were included. RV function was assessed by echocardiography and right heart catheterization before and after LVAD implantation. The survival of the patients was assessed by taking into account parameters before LVAD implantation: right ventricle diastolic diameter RVEDD (normal [N] ≤ 42 mm), tricuspid annular plane systolic excursion TAPSE (N ≥ 16 mm), right ventricle systolic pressure RVSP (N < 40 mmHg), tricuspid regurgitation (TR) degree (N < severe), medium pressure in the right atrium mRAP (N < 8 mmHg), medium pressure in a pulmonary artery mPAP (N ≤ 20 mmHg), pulmonary vascular resistance PVR (N ≤ 2,5 Wood units) and pulmonary artery pulsatility index PAPi (N ≥ 1,85). Comparison of RV function before and after LVAD implantation was assessed on the base RVEDD, TAPSE, RVSP, mPAP, PVR, mRAP. Organ condition was evaluated with laboratory tests (concentration of creatinine, aspartate aminotransferaze AST, alanine aminotranferaze ALT, bilirubin, total protein).<severe),> Results Median age in the moment of LVAD implantation was 59 IQR(49-65) years. The median period of LVAD support was 86 IQR(28-132) months. Normal values of RV function before LVAD implantation were present in 30% of RVEDD; 45% of TAPSE; 47% of RVSP, 77% of TR, 46% of mRAP, 14% of mPAP, 45% of PVR and 52% of PAPi. Death-free survival did not differ between patients with normal and abnormal values of RV parameters (RVEDD p=0,9; TAPSE p=0,27; RVSP p=0,93; TR p=0,22; mRAP p=0,46; mPAP p=0,66; PVR p=0,32; PAPi p=0,63). LVAD therapy was connected with significant decrease of: NTproBNP (p<0,01) and bilirubin concentration (p=0,006), RVEDD (p=0,03), RVSP (p<0,01), mPAP (p=0,008), PVR (p=0,03), as well TAPSE (p<0,01); increase of mRAP (p=0,02) and total protein concentration (p=0,001). The concentration of creatinine (p=0,97), AST (p=0,65) and ALT (p=0,64) did not change significantly. Conclusion LVAD support might be connected with the improvement of RV parameters as a secondary result of unloading of the left ventricle, notwithstanding of TAPSE value. Death-free survival of the patients with normal and suboptimal parameters of the right ventricle before LVAD implantation did not significantly vary. LVAD support was related to the increase of total protein concentration and decrease of bilirubin concentration without an impact on concentrations of AST, ALT and creatinine.</severe),>