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Left ventricular (LV) failure is the cause of death of approximately 30,000 patients in the USA annually, and multiple academic centers have been testing a left ventricular assist device (LVAD) to support these patients until an organ can be provided for heart transplantation. Development of right ventricular (RV) failure during left ventricular support is a major complication increasing morbidity and mortality.
Additional application of a RV assist device (RVAD) may be required in these cases. The need for the RVAD could not be reliably predicted using standard clinical criteria. Investigators blinded to outcome processed the data (587 variables in 400 patients) with PolyAnalyst. 13 patients were predicted to require RVAD, while only 9 of them actually received a RVAD. When comparing results to the real data it was found that out of the four patients left, two died soon postoperatively, third required a high degree of inotropic support but received a heart transplant within 24 hours, and the fourth required weeks of inotropic support.
A simple rule on two hemodynamic parameters reliably predicts which patients would require an additional surgery. This rule will be of great help in deciding in which patients we should or should not re-operate to place an assist device.
Assistant Professor of Anesthesiology
and Critical Care Medicine
University of Pittsburgh