Is Tricuspid Annular Plane Systolic Excursion (TAPSE) Predictor for out Patients with LVAD Right Ventricular Failure in lvad Patients with Preoperative Low Value TAPSE on Mild-term Follow Up

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Abstract

Purpose

Right ventricular (RV) systolic function has a critical role in determining the clinical outcome and the success of using left ventricular assist devices (LVAD) in patients with refractory heart failure. There are some predictors such as Michigan and Penn Risk scores, CVP/PCWP, RVSWI and INTERMACS profiles for early postoperative RV failure in LVAD implantation. We analyzed readmission due to right ventricular failure in LVAD patient with preoperative low values for tricuspid annular plane systolic excursion (TAPSE) on mild-term follow up.

Methods

From June 2013 to October 2017, 61 patients who had discharged successfully underwent LVAD implantation at our department. Patients were divided into two groups according to the preoperative TAPSE. Group A (n = 24) was TAPSE of ≤12 mm and Group B (n= 37) was TAPSE of >12 mm. Statistical methods for the analysis of recurrent events with a terminal event were performed to evaluate readmission due to RVF. Demographics and outcomes were compared between these two groups.

Results

Of sixty-one patients, mean age was 42.3 ± 13.7 (19-67) years, 20% were women, mean follow up time were 663.6 ± 391 (92-1571) days, median TAPSE was 13 (6-20) mm, dilated cardiomyopathy 62,2%, fourteen (23%) patients were performed heart transplantation, readmission due to RVF was 11% (in group A 2 patients, in group B 5 patients), there was no difference between the two groups with regard to compared RVF on mild term follow up (p:0,53). Two (28,5%) patients patients died due to pump thrombosis after RVF event, a patient was performed heart transplantation, four (57%) patients is followed with medical treatment on out of hospital. A patient died due to pump thrombosis in grup B.

Conclusion

Right ventricular (RV) dysfunction following implantation of a LVAD is a serious condition and is associated with increased mortality. We use some scores and predictors such as TAPSE for early postoperative RVF but the absolute there are needed new predictors for RVF with LVAD patients who out of hospital on long term follow up.

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