• Henryk Welp, Jürgen R Sindermann, Heinz Deschka, Sven Martens, and Mirela Scherer.
• Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany. Electronic address: henryk.welp@ukmuenster.de.
• J. Cardiothorac. Vasc. Anesth. 2016 Jun 1; 30 (3): 627-31.

ObjectivesRight heart failure still occurs in up to 20% of patients after implantation of a left ventricular assist device (LVAD). One treatment option for these patients is the implantation of a temporary right ventricular assist device (RVAD). Experimental data suggest that non-pulsatile perfusion of the lungs is associated with an increased rate of pulmonary hemorrhage. The aim of this study was to determine the incidence of pulmonary bleeding complications in these patients.DesignObservational study.SettingSingle center, university hospital.ParticipantsThis study included patients undergoing LVAD implantation for end-stage heart failure and subsequent implantation of a temporary right ventricular support system.InterventionsIn this study, 25 patients who underwent LVAD and additional temporary RVAD implantation were screened for pulmonary bleeding complications.Measurements And Main ResultsThe mean Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level at the time of LVAD implantation was 2.84. All patients experienced severe right ventricular failure (tricuspid annular plane systolic excursion [TAPSE], 10.16±26.3 mm) and severe pulmonary hypertension (right atrial [RA] pressure, 56.21±15.58 mmHg). Average duration of right ventricular support was 11.12±7.20 days, with right ventricular support being administered to 14 patients for more than 7 days. Seventeen patients were weaned successfully from right ventricular support after a mean support duration of 5 days. Five patients developed pulmonary bleeding complications, diagnosed using computed tomography scan and bronchoscopy. All bleeding occurred after postoperative day 7 and was associated with RVAD flow of more than 4 L/min within 24 hours before bleeding occurred.ConclusionsThe data presented in this study suggested that right ventricular support for more than 7 days and a blood flow greater than 4 L/min were associated with pulmonary bleeding complications. This should be taken into consideration when temporary right ventricular support after LVAD implantation is planned.Copyright © 2016 Elsevier Inc. All rights reserved.

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