https://doi.org/10.1007/s00392-025-02737-x
1Universitätsklinikum Essen Klinik für Kardiologie und Angiologie Essen, Deutschland; 2Universitätsklinikum Essen Klinik für Thorax- und Kardiovaskuläre Chirurgie Essen, Deutschland
Background and aims: Left ventricular assist devices (LVADs) are a treatment option for patients with end-stage heart failure. Despite advancements in device technology, rehospitalizations due to infections and decompensated heart failure remain common. Right ventricular (RV) dysfunction is routinely assessed using tricuspid annular plane systolic excursion (TAPSE), and is thought to impact prognosis, but data on the predictive impact of pre-transplant RV function are sparse. We aim to investigate pre-implant RV function as an outcome predictor in patients under LVAD therapy.
Methods: All consecutive LVAD patients between October 2017 and August 2024 were included and retrospectively analyzed. Clinical, echocardiographic and laboratory parameters were collected before and after implantation. Complications were classified as early (<30 days) or late events. Patients were stratified according to their pre-implantation RV function, as assessed TAPSE into preserved (≥ 16 mm, n=16) and reduced (< 16 mm, n=24) groups.
Results: A total of 53 patients who received LVAD therapy for terminal heart failure were analyzed, including 17 (32.1%) patients with DCM and 22 with ischemic heart failure (41.5%; ICM). The mean age was 53.98 ± 11.74 years, 90,6% were male, and 40 (75.5%) patients had pre-implantation TAPSE parameter available for analysis. RV functional parameter assessed by marked RV dilatation (12.5% vs. 41.7%, p=0.07), moderate-to-severe tricuspid regurgitation (37.5% vs. 41.6%, p=0.72) and need for RV assist device implantation (0% vs. 16.7%, p=0.14) did not differ between the groups. In total (preserved versus (vs.) reduced TAPSE), 31 (12 (75.0%) vs. 19 (79.2%), p=1.00) early- and 134 (66 vs. 68, p=0.33) long-term complications, including driveline infections (27.3% vs. 33.8%, p=0.18), leading to unplanned rehospitalizations were documented. Mortality did not differ between the groups (25.0% vs. 16.7%, p=0.69).
Conclusion: Pre-implant right heart function assessed by TAPSE was not associated with adverse outcomes in LVAD patients. TAPSE did not independently correlate with other RV functional status parameter including moderate and severe TR or RV dilation.