Clinical Outcome of Patients with Reduced Right Ventricular Stroke Work Index Post Left Ventricular Assist Device Implantation

Background: In patients with advanced heart failure (HF) supported with left ventricular (LV) assist devices (LVADs), right ventricular (RV) systolic dysfunction heavily affects their morbidity and mortality. RV stroke work index (RVSWI) is an important measure in the assessment of RV function (RVF) in patients prior to LVAD implantation aimed to foretell the risk for RV failure. However, data regarding the correlation between RVSWI and clinical outcomes in LVADs patients are limited.

Methods: A single-center retrospective analysis of patients who underwent LVAD implantation (HeartMate2, HeartMate 3 and HeartWare) at our institution between 2008-2017. Patients were categorized by RVSWI values based on angiographic hemodynamic measurements prior to implantation. Patients were followed for 18 months.

Results: Our cohort included 86 patients of whom 15 (17%) had RVSWI < 450g*m/m².

Baseline parameters between groups were similar regarding age, SPAP, mod. to severe RV dysfunction evaluated by echo, PVR, mean PA pressure. Patients with reduced RVSWI had higher RA pressure (14 mmHg) compared to normal RVSWI (8mmHG).

Our findings did not show significant differences between patients with reduced versus normal RVSWI in the rates of LVAD-related and non-LVAD related infections, thrombotic events, overall stroke, malignant ventricular arrhythmias and bleeding episodes (p=NS). All-cause mortality between patients with reduced RVSWI and patients with normal RVSWI was also comparable (13% and 15%, respectively, p=0.49). None of the patients in the reduced RVSWI needed RVAD support or dialysis.

Conclusion: In our cohort patients with reduced RVSWI had similar baseline parameters compared to patients with normal RVSWI. Mid-term clinical outcomes including survival were similar. Although RVSWI is an acceptable predictor of RVF prior to LVAD implantation in our cohort this parameter did not influence mortality or need for RV support post LVAD implantation. We believe the evaluation of RVF pre-LVAD implantation should be based on a multifactorial assessment.