Right ventricular failure following left ventricular assist device implantation is associated with a preoperative pro-inflammatory response

• Published in: Journal of cardiothoracic surgery Vol. 14; no. 1; p. 80
• Main Authors: Tang, Paul C, Haft, Jonathan W, Romano, Matthew A, Bitar, Abbas, Hasan, Reema, Palardy, Maryse, Aaronson, Keith D, Pagani, Francis D
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 25-04-2019; BioMed Central; BMC
• Subjects: Adult; Aged; Analysis; Aorta; Assisted Circulation - adverse effects; Balloon treatment; C-reactive protein; C-Reactive Protein - analysis; Chemokines; Congestive heart failure; Creatinine; Cytokines; Female; Heart; Heart failure; Heart Failure - blood; Heart Failure - complications; Heart Failure - physiopathology; Heart Failure - surgery; Heart rate; Heart-Assist Devices - adverse effects; Humans; Implantation; Inflammation; Inflammatory response; Intra-Aortic Balloon Pumping; L-Lactate dehydrogenase; Laboratories; Lactate dehydrogenase; Lactic acid; Left ventricular assist device; Leukocyte Count; Leukocytes; Leukocytosis; Male; Medical prognosis; Middle Aged; Patients; Preoperative Period; Prognosis; Prospective Studies; Regression analysis; Retrospective Studies; Right ventricular failure; Statistical analysis; Survival; Survival analysis; Systemic Inflammatory Response Syndrome - blood; Systemic Inflammatory Response Syndrome - complications; Systemic Inflammatory Response Syndrome - physiopathology; Transplants & implants; Tumor necrosis factor-TNF; Ventricle; Ventricular Dysfunction, Right - blood; Ventricular Dysfunction, Right - etiology; Ventricular Dysfunction, Right - physiopathology; White blood cell count; Heart failure; Left ventricular assist device; Inflammation; Right ventricular failure
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-019-0895-x

Systemic inflammation during implant of a durable left ventricular assist device (LVAD) may contribute to adverse outcomes. We investigated the association of the preoperative inflammatory markers with subsequent right ventricular failure (RVF).
Prospective data was collected on 489 patients from 2003 through 2017 who underwent implantation of a durable LVAD. Uni- and multivariable correlation with leukocytosis was determined using linear and binary logistic regression. The population was also separated into low (< 10.5 K/ul, n = 362) and high (> 10.5 K/ul, n = 127) white blood cell count (WBC) groups. Mantel-Cox statistics was used to analyze survival data.
Postop RVF was associated with a higher preop WBC (11.3 + 5.7 vs 8.7 + 3.1) and C-reactive protein (CRP, 5.6 + 4.4 vs 3.3 + 4.7) levels. Multivariable analysis identified an independent association between increased WBC preoperatively with increased lactate dehydrogenase (LDH, P < 0.001), heart rate (P < 0.001), CRP (P = 0.006), creatinine (P = 0.048), and INR (P = 0.049). The high WBC group was more likely to be on preoperative temporary circulatory support (17.3% vs 6.4%, P < 0.001) with a trend towards greater use of an intra-aortic balloon pump (55.9% vs 47.2%, P = 0.093). The high WBC group had poorer mid-term survival (P = 0.042).
Postop RVF is associated with a preoperative pro-inflammatory environment. This may be secondary to the increased systemic stress of decompensated heart failure. Systemic inflammation in the decompensated heart failure may contribute to RVF after LVAD implant.