Neurohumoral and inflammatory markers for prediction of right ventricular failure after implantation of a left ventricular assist device

• Published in: General thoracic and cardiovascular surgery 2011-01, Vol.59 (1), p.19-24
• Main Authors: Hennig, Felix, Stepanenko, Alexander V., Lehmkuhl, Hans B., Kukucka, Marian, Dandel, Michael, Krabatsch, Thomas, Hetzer, Roland, Potapov, Evgenij V.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biomarkers - blood; Cardiac Surgery; Cardiology; Chi-Square Distribution; Creatinine; Female; Germany; Heart failure; Heart Failure - physiopathology; Heart Failure - therapy; Heart-Assist Devices - adverse effects; Humans; Inflammation Mediators - blood; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Peptide Hormones - blood; Retrospective Studies; Risk Assessment; Risk Factors; Surgical Oncology; Thoracic Surgery; Treatment Outcome; Ventricular Dysfunction, Right - blood; Ventricular Dysfunction, Right - etiology; Ventricular Dysfunction, Right - physiopathology; Ventricular Function, Left; Ventricular Function, Right; Young Adult
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-010-0669-9

Purpose Implantation of a left ventricular assist device (LVAD) is an established treatment for end-stage heart failure. Right ventricular dysfunction develops in 20%–50% of patients after device implantation, leading to prolonged hospital stays and elevated mortality rates. However, prediction of right ventricular failure remains difficult. Methods A total of 40 patients who received an LVAD for chronic end-stage heart failure between May 2001 and December 2002 were evaluated. The patients were divided retrospectively into two groups: group I ( n = 26), with no apparent postoperative right ventricular failure; and group II ( n = 14), with right ventricular failure after implantation defined by the presence of two of the following criteria during the first week after surgery: mean arterial pressure ≤55 mmHg, central venous pressure ≥16 mmHg, mixed venous saturation ≤55%, cardiac index 20 units or an apparent need for mechanical right ventricular support. Hemodynamic, echocardiographic, neurohumoral, and inflammatory parameters were evaluated 24 h before implantation of the LVAD. Results Levels of procalcitonin, neopterin, n-terminalpro-brain natriuretic peptide, and big endothelin-1 were significantly lower in group I: 0.106 vs. 0.322 ng/ml, P = 0.048; 10.5 vs. 20.7 ng/ml, P = 0.018; 6322 vs. 17174 pg/ml, P = 0.032; 1.6 vs. 19.5 pg/ml, P = 0.02, respectively. Levels of creatinine kinase and creatinine were significantly lower in group I than in group II: 24 vs. 40 U/l, P = 0.034; 1.3 vs. 2.3 mg/dl, P = 0.008, respectively. Conclusion Preoperative evaluation of markers of inflammation and neurohumoral activation may provide additional information for predicting right ventricular failure after implantation of an LVAD.