J Thorac Cardiovasc Surg. 2023 Jul 24:S0022-5223(23)00624-4. doi: 10.1016/j.jtcvs.2023.07.019. Online ahead of print.
ABSTRACT
INTRODUCTION: Right heart output in heart failure can be compensated through increasing systemic venous pressure. We determined whether this “Passive Cardiac Output” magnitude can predict LVAD outcomes.
METHODS: Retrospective review of 383 patients who received a continuous flow LVAD at the University of Michigan from 2012 to 2021. Pre-LVAD cardiac output driven by venous pressure was determined by dividing right atrial by mean pulmonary artery pressure, multiplied by total cardiac output. Normalization to body surface area derives the “Passive Cardiac Index (PasCI)”. Youden J statistics identified the PasCI threshold which predicted LVAD death by 2 years.
RESULTS: Increased preoperative PasCI was associated with reduced survival (HR=2.27, P<0.01), and increased risk of right ventricular failure (RVF) (HR=3.46, P=0.04). Youden analysis showed that a preoperative PasCI >0.5 (n=226) predicted LVAD death (P=0.10). Patients with Passive CI >0.5 had poorer survival (P=0.02), with a trend toward more heart failure readmission days (45.09+67.64 vs 35.13+45.02 days, P=0.084) and increased gastrointestinal bleeding (29.2% vs 20.4%, P=0.052). Additionally, of the 97 patients who experienced readmissions for heart failure, those with pre-LVAD implantation Passive CI >0.5 were more likely to have >1 readmission (P= 0.05).
CONCLUSIONS: While right heart output can be augmented by raising venous pressure, this negatively impacts end-organ function and increases heart failure readmission days. Patients with a pre-LVAD PasCI >0.5 have worse post-LVAD survival and increased RVF. Utilizing the PasCI metric in isolation or incorporation into a predictive model may improve the management of LVAD candidates with RV dysfunction.
PMID:37495169 | DOI:10.1016/j.jtcvs.2023.07.019
