Degree of change in right ventricular adaptation measures during axillary Impella support informs risk stratification for early, severe right heart failure following durable LVAD implantation

Brian Hsi, Denny Joseph, Barry Trachtenberg, Arvind Bhimaraj, Erik E. Suarez, Jiaqiong Xu, Ashrith Guha, Ju H. Kim

Research output: Contribution to journalArticlepeer-review

Abstract

Risk assessment for early, severe right heart failure (RHF) after LVAD implantation remains imperfect. We sought to define the differences in RV adaptation and load after axillary Impella support between patients who experienced RHF and those who did not. Seventeen of 18 patients included were deemed intermediate or high risk for RHF by EUROMACS-RHF score. Before Impella insertion, RV adaptation parameters (RAP, RAP:PCWP, PAPi) were worse in the non-RHF group compared to the RHF group. In both groups, RV load parameters (effective pulmonary arterial elastance, pulmonary vascular resistance, and pulmonary vascular compliance) improved after Impella insertion. Lesser improvements in RV adaptation were seen in the RHF group. Moreover, load-to-adaptation relationships (EA/RAP and EA/RAP:PCWP) worsened to a greater degree. In patients at intermediate or high risk for RHF after LVAD, assessment of RV adaptation and load during axillary Impella support may improve risk stratification.

Original languageEnglish (US)
Pages (from-to)279-282
Number of pages4
JournalJournal of Heart and Lung Transplantation
Volume41
Issue number3
DOIs
StatePublished - Mar 2022

Keywords

  • Impella
  • LVAD
  • Right heart failure

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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