Abstract 14318: Right Ventriculo- Arterial Coupling Assessment by High-Fidelity Hemodynamic Measurements in Patients Undergoing Left Ventricular Assist Device Implantation
Nicoara, A; Culp, C; Cooter, MW; Hunter, K; Krasuski, R; Fudim, M; Schroder, J; Milano, C; Cherry, AD; Podgoreanu, MV
Published in: Circulation
The changes in RV function after LVAD placement are not fully understood. RV- PA coupling, defined as the ratio of RV end-systolic to arterial elastances (E
/E
), offers unique insight into the cardiopulmonary unit and opportunity to address these knowledge gaps. We present early results from our study investigating RV adaptive changes after LVAD implantation by intraoperative placement of RV conductance catheters.
Conductance catheter, echocardiographic, and hemodynamic data were gathered starting on the day of surgery. We used a 7Fr high-fidelity RV conductance catheter delivered through a 9Fr central venous sheath. P-V loop parameters were obtained before skin incision and after chest closure. Single- beat methods were used for E
/E
determination. Early RVF was defined according to INTERMACS criteria. Intraoperative pre- and post-implantation echocardiographic and hemodynamic parameters were compared.
We present data on the first 14 patients who underwent successful placement of the RV conductance catheter. Moderate or severe RVF occurred in 3 patients (21.4%). Data are presented in the table. While overall E
(1.2 vs 1.3, p=0.785), E
(1.1 vs 1.3, p=0.154), and RV-PA coupling (E
/E
ratio 1.1 vs 1.0, p=0.129 ) remained unchanged, several patients underwent dramatic changes, either increase or decrease, in E
and E
(Figure). Measures of energetic expense, such as stroke work ( SW, correlate of myocardial energy transferred) and pressure-volume area (PVA, correlate of myocardial oxygen consumption) significantly decreased after LVAD implantation.
We have shown that RV function assessment using conductance catheters and 3D echocardiography is feasible and able to identify individual responses in RV-PA coupling after LVAD implantation. Continued accrual of data will help identify different phenotypes of RV adaptation and establish a cut-off level of RV-PA uncoupling at which RVF occurs.
