Background Right ventricular failure (RVF) is one of the most serious complications following placement of a left ventricular assist device (LVAD). Several scores have been proposed to identify patients at high risk of RVF, although their predictive role, under the current use is suboptimal. The effects of intra-aortic balloon pump (IABP) on clinical conditions and on risk scores for RVF among end-stage heart failure (HF) patients with biventricular dysfunction is not known. Methods and Results Thirty-two end-stage HF patients (mean age 52±11 years, 72% males, 53% with non ischemic dilated cardiomyopathy, mean LVEF 15±4%, echocardiographic severe RV dysfunction in 84%) subjected to long-term IABP as a bridge to cardiac transplant were studied. We calculated the following two RVF risk scores (RS) after Fitzpatrick (J Heart Lung Transplant 2008) with low and high risk for scores < 50 and ≥ 50 respectively (RVFRS1) and after Matthews (J Am Coll Cardiol 2008) with low, intermediate and high risk for scores ≤ 3, 4-5 and ≥ 5.5, respectively (RVFRS 2). High risk patients accounted for 52% and 47% of the population according to RVFRS 1 and 2, respectively. RVFRS1 was significantly reduced one week after IABP positioning from 50±18 to 38±19 (p<0.001). Patients with high risk scores were reduced from 52% to 14% (p<0.01). RVFRS2 also was significantly reduced, from 5.5±2.4 to 2.5±2.1 (p<0.0001). Patients with high risk scores were reduced from 15/32 (47%) to 4/32 (12%, p< 0.001). Bilirubin and creatinine were significantly reduced from (3.0±2.4 to 2.2±1.7, p=0.0013 and 1.76±0.85 to 1.16±0.44, p=0.0001, respectively). Conclusions Among patients with end-stage biventricular heart failure, few days of IABP significantly improved risk scores for RVF, leaving only few patients with scores predicting high risk. The results suggest that the use of IABP for several days before LVAD may reduce the risk of post-operative RVF and that it may help in the identification of patients who, showing the persistence of high risk features after IABP, are truly at high risk and deserve a biventricular assist device.
Effects of Intra-Aortic Balloon Pump on Markers of Right Ventricular Dysfunction Among End-Stage Heart Failure Patients Candidates to Cardiac Transplant or Ventricular Assist Device
G.M. De Ferrari
Co-last
2011-01-01
Abstract
Background Right ventricular failure (RVF) is one of the most serious complications following placement of a left ventricular assist device (LVAD). Several scores have been proposed to identify patients at high risk of RVF, although their predictive role, under the current use is suboptimal. The effects of intra-aortic balloon pump (IABP) on clinical conditions and on risk scores for RVF among end-stage heart failure (HF) patients with biventricular dysfunction is not known. Methods and Results Thirty-two end-stage HF patients (mean age 52±11 years, 72% males, 53% with non ischemic dilated cardiomyopathy, mean LVEF 15±4%, echocardiographic severe RV dysfunction in 84%) subjected to long-term IABP as a bridge to cardiac transplant were studied. We calculated the following two RVF risk scores (RS) after Fitzpatrick (J Heart Lung Transplant 2008) with low and high risk for scores < 50 and ≥ 50 respectively (RVFRS1) and after Matthews (J Am Coll Cardiol 2008) with low, intermediate and high risk for scores ≤ 3, 4-5 and ≥ 5.5, respectively (RVFRS 2). High risk patients accounted for 52% and 47% of the population according to RVFRS 1 and 2, respectively. RVFRS1 was significantly reduced one week after IABP positioning from 50±18 to 38±19 (p<0.001). Patients with high risk scores were reduced from 52% to 14% (p<0.01). RVFRS2 also was significantly reduced, from 5.5±2.4 to 2.5±2.1 (p<0.0001). Patients with high risk scores were reduced from 15/32 (47%) to 4/32 (12%, p< 0.001). Bilirubin and creatinine were significantly reduced from (3.0±2.4 to 2.2±1.7, p=0.0013 and 1.76±0.85 to 1.16±0.44, p=0.0001, respectively). Conclusions Among patients with end-stage biventricular heart failure, few days of IABP significantly improved risk scores for RVF, leaving only few patients with scores predicting high risk. The results suggest that the use of IABP for several days before LVAD may reduce the risk of post-operative RVF and that it may help in the identification of patients who, showing the persistence of high risk features after IABP, are truly at high risk and deserve a biventricular assist device.
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