Abstract Background Patients with end-stage heart failure often experience fatal ventricular arrhythmias (FVA), which significantly impact their prognosis and quality of life. Even after implantation of a left ventricular assist device (LVAD), FVA can cause serious complications, including hypotension, low pump flow, and worsening aortic regurgitation. Although risk factors for post-discharge FVA in LVAD patients have been studied, the role of preoperative hemodynamic parameters remains controversial. This study aims to evaluate the association between preoperative hemodynamics and the occurrence of postoperative FVA in LVAD patients. Methods We retrospectively analyzed medical records of 260 patients who underwent LVAD implantation between January 1, 2012, and December 31, 2022. Patients who had available preoperative right heart catheterization data and had been discharged at least once after LVAD implantation were included in the study. Patients younger than 18 years, those who underwent LVAD pump exchange, or those who never left the hospital postoperatively were excluded. Of these, 174 patients had no prior history of FVA before LVAD implantation. We assessed the occurrence of de novo FVA and examined whether preoperative hemodynamic parameters influenced its development. Results Among the 260 patients, 41 (15.8%) experienced FVA after hospital discharge. A total of 69 patients (26.5%) had a history of FVA before LVAD implantation. Patients who developed FVA postoperatively had a significantly higher prevalence of preoperative FVA (56% vs. 21%, P 0.0001). However, no significant differences were observed between patients with and without postoperative FVA in terms of preoperative right heart catheterization findings, laboratory data, or echocardiographic parameters. In the subgroup analysis of 174 patients without a prior history of FVA, multivariable logistic regression analysis, adjusting for age, sex, preoperative implantable cardioverter defibrillator (ICD) presence, and pulmonary artery wedge pressure (PAWP), revealed that higher preoperative PAWP was an independent predictor for de novo FVA after LVAD implantation (OR 1.1, 95% CI 1.01-1.14, P = 0.0279). Conclusion Preoperative FVA history is a significant risk factor for postoperative FVA in LVAD patients. Furthermore, in patients without preoperative FVA, high PAWP before LVAD implantation is an independent predictor of de novo FVA development after surgery. Patients after LVAD implantation who had High PAWP preoperatively may need to be aware of the appearance of de novo FVA after discharge.
Ôta et al. (Sat,) studied this question.