• Natalie A Silverton, Ravi Patel, Josh Zimmerman, Jianing Ma, Greg Stoddard, Craig H Selzman, and Candice K Morrissey.
• Department of Anesthesiology, School of Medicine, University of Utah, Salt Lake City, UT. Electronic address: natalie.silverton@hsc.utah.edu.
• J. Cardiothorac. Vasc. Anesth. 2018 Oct 1; 32 (5): 2096-2103.

ObjectiveTo determine whether intraoperative measures of right ventricular (RV) function using transesophageal echocardiography are associated with subsequent RV failure after left ventricular assist device (LVAD) implantation.DesignRetrospective, nonrandomized, observational study.SettingSingle tertiary-level, university-affiliated hospital.ParticipantsThe study comprised 100 patients with systolic heart failure undergoing elective LVAD implantation.InterventionsTransesophageal echocardiographic images before and after cardiopulmonary bypass were analyzed to quantify RV function using tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (S'), fractional area change (FAC), RV global longitudinal strain, and RV free wall strain. A chart review was performed to determine which patients subsequently developed RV failure (right ventricular assist device placement or prolonged inotrope requirement ≥14 days).Measurements And Main ResultsNineteen patients (19%) subsequently developed RV failure. Postbypass FAC was the only measure of RV function that distinguished between the RV failure and non-RV failure groups (21.2% v 26.5%; p = 0.04). The sensitivity, specificity, and area under the curve of an abnormal RV FAC (<35%) for RV failure after LVAD implantation were 84%, 20%, and 0.52, respectively. No other intraoperative measure of RV function was associated with subsequent RV failure. RV failure increased ventilator time, intensive care unit and hospital length of stay, and mortality.ConclusionIntraoperative measures of RV function such as tricuspid annular plane systolic excursion, tricuspid annular systolic velocity, and RV strain were not associated with RV failure after LVAD implantation. Decreased postbypass FAC was significantly associated with RV failure but showed poor discrimination.Copyright © 2018 Elsevier Inc. All rights reserved.

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