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A New Hemodynamic Index To Predict Late Right Failure In Patients Implanted With Last Generation Centrifugal Pump.
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  • Andrea Montalto,
  • Cristiano Amarelli,
  • Vito Piazza,
  • Kali Hopkins,
  • Marina Comisso,
  • Romina Pantanella,
  • Francesco Musumeci
Andrea Montalto
San Camillo Forlanini Hospital
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Cristiano Amarelli
Azienda Ospedaliera Monaldi
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Vito Piazza
San Camillo Forlanini Hospital
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Kali Hopkins
Northwestern University Feinberg School of Medicine
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Marina Comisso
San Camillo Forlanini Hospital
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Romina Pantanella
San Camillo Forlanini Hospital
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Francesco Musumeci
San Camillo Forlanini Hospital
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Abstract

Background. Right ventricular failure (RVF) is a severe event that increases perioperative mortality after Left Ventricle Assist Device (LVAD) implantation. RV function is particularly affected by the LVAD speed by changing RV preload and afterload as well as the position of the interventricular septum. However, there are no studies focusing on the relationship between pump speed optimization and risk factors for development of lateRVF. Methods. Between 2015 and 2019,50 consecutive patients received LVAD implantation at San Camillo Hospital in Rome. Of these, 38 who underwent pump speed optimization were included. Post optimization hemodynamic data were collected. We assessed: a new Hemodynamic Index (HI), calculated as follows HI=MAP x PCWP/CVP x RPM set/RPM max; risk factors for late RVF, which was defined as the requirement for 7 days or more of inotropic support. Results 10 patients had late RVF after LVAD implantation. 5 patients required diuretic therapy and speed optimization. In 3 patients inotropic support with adrenaline 0.05 g/kg/min was started. 2 patients required prolonged continuous veno-venous hemofiltration and high dosage inotropic support. Multivariate analysis revealed that a low HI (odds ratio 11.5, 95 % confidence interval,1.85-65.5,p[.003] was an independent risk factor for late RVF after LVAD implantation. Conclusion A low HI, according to our study, is a significant risk factor for the development of RVF after LVAD implantation. We suggest adopting this index during the follow-up to stratify the different hemodynamic profiles and modify the therapeutic strategies according to the different HI levels obtained for every single patient.

Peer review status:ACCEPTED

02 Dec 2020Submitted to Journal of Cardiac Surgery
16 Jan 2021Submission Checks Completed
16 Jan 2021Assigned to Editor
16 Jan 2021Reviewer(s) Assigned
21 Jan 2021Review(s) Completed, Editorial Evaluation Pending
21 Jan 2021Editorial Decision: Revise Major
04 Feb 20211st Revision Received
15 Feb 2021Submission Checks Completed
15 Feb 2021Assigned to Editor
15 Feb 2021Reviewer(s) Assigned
21 Feb 2021Review(s) Completed, Editorial Evaluation Pending
21 Feb 2021Editorial Decision: Revise Minor
25 Feb 20212nd Revision Received
25 Feb 2021Submission Checks Completed
25 Feb 2021Assigned to Editor
25 Feb 2021Reviewer(s) Assigned
26 Feb 2021Review(s) Completed, Editorial Evaluation Pending
26 Feb 2021Editorial Decision: Revise Minor
12 Mar 20213rd Revision Received
13 Mar 2021Assigned to Editor
13 Mar 2021Submission Checks Completed
13 Mar 2021Reviewer(s) Assigned
28 Mar 2021Review(s) Completed, Editorial Evaluation Pending
28 Mar 2021Editorial Decision: Accept