• Alina Nicoara, WrightMary CooterMCDepartment of Anesthesiology,Duke University Medical Center, 2301 Erwin Rd, Box #3094, Durham, NC 27710, United States., Daniel Rosenkrans, Chetan B Patel, Jacob N Schroder, Anne D Cherry, Nazish K Hashmi, Angela L Pollak, Sharon L McCartney, Jason Katz, Carmelo A Milano, and Mihai V Podgoreanu.
• Department of Anesthesiology,Duke University Medical Center, 2301 Erwin Rd, Box #3094, Durham, NC 27710, United States. Electronic address: alina.nicoara@duke.edu.
• J. Cardiothorac. Vasc. Anesth. 2022 Oct 1; 36 (10): 3740-3746.

ObjectivesThe prediction of right heart failure (RHF) after left ventricular assist device (LVAD) implantation remains a challenge. Recently, risk scores were derived from analysis of the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) data, the EUROMACS-RHF, and the modified postoperative EUROMACS-RHF. The authors assessed the performance characteristics of these 2 risk score formulations in a continuous-flow LVAD cohort at their institution.DesignA retrospective, observational study.SettingAt a tertiary-care academic medical center.ParticipantsAdult patients who underwent durable LVAD implantation between 2015 and 2018.InterventionsNone MEASUREMENTS AND MAIN RESULTS: Early post-LVAD RHF was defined as follows: (1) need for right ventricular assist device, or (2) inotropic or inhaled pulmonary vasodilator support for ≥14 postoperative days. The authors used logistic regression and examined receiver operating characteristic (ROC) curves to evaluate the ability of the 2 risk scores to distinguish between outcome groups. A total of 207 patients met the inclusion criteria. Of the patients, 16% developed RHF (33/207). The EUROMACS-RHF score was not predictive of RHF in the authors' cohort (odds ratio [OR] 1.25; 95% CI [0.99-1.60]; p = 0.06), but the postoperative EUROMACS-RHF CPB score was significantly associated (OR 1.38; 95% CI [1.03-1.89]; p = 0.03). The scores had similar ROC curves, with weak discriminatory performance: 0.601 (95% CI [0.509-0.692]) and 0.599 (95% CI [0.505-0.693]) for EUROMACS-RHF and postoperative EUROMACS-RHF, respectively.ConclusionsIn the authors' single-center retrospective analysis, the EUROMACS-RHF risk score did not predict early RHF. An optimized risk score for the prediction of RHF after LVAD implantation remains an urgent unmet need.Copyright © 2022 Elsevier Inc. All rights reserved.

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