Perioperative Predictors of Right Ventricular Failure Following Left Ventricular Assist Device Implantation

Right ventricular failure (RVF) is an important complication following implantation of a left ventricular assist device (LVAD) in patients with advanced heart failure. This study aims to identify perioperative hemodynamic predictors of RVF following LVAD implantation and develop an internally validated predictive model. Patients who underwent LVAD implantations between March 2013 and March 2023 at a large-volume tertiary center were retrospectively analyzed. The primary outcome was early post-implant RVF, defined by need for right ventricular assist device (RVAD), prolonged inotrope dependence (> 14 days), or death within 14 days while on inotropes. Perioperative hemodynamic variables were analyzed using univariate logistic regression. A prediction model was then developed using stepwise multivariate logistic regression, and internally validated using k-fold cross-validation. Among 210 patients, 73 patients (34.8%) developed early post-implant RVF. Decreased post-implant cardiac index (odds ratio [OR]: 0.0122, p = 0.001), decreased mean arterial pressure (OR: 0.932, p = 0.008), and simultaneously increased cardiac index and pulmonary pulse pressure (OR: 1.13, p = 0.021) independently predicted RVF. Preimplantation IV inotrope therapy was a significant confounder (OR: 3.96, p = 0.021). Our proposed predictive model achieved strong discriminatory power (area under the curve [AUC] of 0.830) and stable cross-validation performance. External validation with multicenter cohorts is warranted to confirm predictive accuracy and clinical applicability.