Risk score derived from pre-operative data analysis predicts the need for biventricular mechanical circulatory support

J Heart Lung Transplant. 2008 Dec;27(12):1286-92. doi: 10.1016/j.healun.2008.09.006.


Background: Right ventricular (RV) failure after left ventricular assist device (LVAD) placement is a serious complication and is difficult to predict. In the era of destination therapy and the total artificial heart, predicting post-LVAD RV failure requiring mechanical support is extremely important.

Methods: We reviewed patient characteristics, laboratory values and hemodynamic data from 266 patients who underwent LVAD placement at the University of Pennsylvania from April 1995 to June 2007.

Results: Of 266 LVAD recipients, 99 required RV assist device (BiVAD) placement (37%). We compared 36 parameters between LVAD (n = 167) and BiVAD patients (n = 99) to determine pre-operative risk factors for RV assist device (RVAD) need. By univariate analysis, 23 variables showed statistically significant differences between the two groups (p < or = 0.05). By multivariate logistic regression, cardiac index < or =2.2 liters/min/m(2) (odds ratio [OR] 5.7), RV stroke work index < or =0.25 mm Hg . liter/m(2) (OR 5.1), severe pre-operative RV dysfunction (OR 5.0), pre-operative creatinine > or =1.9 mg/dl (OR 4.8), previous cardiac surgery (OR 4.5) and systolic blood pressure < or =96 mm Hg (OR 2.9) were the best predictors of RVAD need.

Conclusions: The most significant predictors for RVAD need were cardiac index, RV stroke work index, severe pre-operative RV dysfunction, creatinine, previous cardiac surgery and systolic blood pressure. Using these data, we constructed an algorithm that can predict which LVAD patients will require RVAD with >80% sensitivity and specificity.

MeSH terms

  • Adult
  • Aged
  • Blood Pressure
  • Diabetes Complications / epidemiology
  • Equipment Design
  • Female
  • Heart Failure / physiopathology*
  • Heart Failure / surgery
  • Heart Transplantation*
  • Heart-Assist Devices* / adverse effects
  • Hemodynamics
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Ventricular Dysfunction, Left / epidemiology
  • Ventricular Dysfunction, Left / physiopathology
  • Ventricular Dysfunction, Left / surgery*
  • Ventricular Dysfunction, Right / physiopathology
  • Ventricular Dysfunction, Right / surgery*
  • Ventricular Function, Right