Risk Score Derived from Pre-operative Data Analysis Predicts the Need for Biventricular Mechanical Circulatory Support

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 (RVA.D) need. By univariate analysis, 23 variables showed statistically significant differences between the two groups (p <= 0.05). By multivariate logistic regression, cardiac index <= 2.2 liters/min/m(2) (odds ratio [OR] 5.7), RV stroke work index <= 0.25 mm Hg.liter/m(2) (OR 5.1), severe pre-operative RV dysfunction (OR 5.0), pre-operative creatinine >= 1.9 mg/dl (OR 4.8), previous cardiac surgery (OR 4.5) and systolic blood pressure <= 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. J Heart Lung Transplant 2008,27:1286-92. Copyright (C) 2008 by the International Society for Heart and Lung Transplantation.