• Andrej Alfirevic, Natalya Makarova, Marta Kelava, Shiva Sale, Edward Soltesz, and Andra E Duncan.
• Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH. Electronic address: alfirea@ccf.org.
• J. Cardiothorac. Vasc. Anesth. 2020 May 1; 34 (5): 1204-1210.

ObjectivesRight ventricular failure after left ventricular assist device implantation increases postoperative morbidity and mortality. Whether intraoperative echocardiographic and hemodynamic measurements predict right ventricular failure is unclear. Speckle-tracking-derived tricuspid annulus displacement may provide a useful, effective, and straightforward predictor of severe right ventricular failure in patients having left ventricular device implantation. The aim of this study was to determine if intraoperative tricuspid annulus displacement is a stronger discriminator compared with the global longitudinal strain and modified tricuspid annular plane systolic excursion, the Michigan risk score, and pulmonary artery pulsatility index.DesignRetrospective analysis.SettingA tertiary-care referral center.ParticipantsPatients scheduled for left ventricular assist device implantation from January 2010 to December 2017.InterventionsNone MEASUREMENTS AND MAIN RESULTS: The authors examined 86 patients undergoing left ventricular assist device implantation with adequate intraoperative echocardiographic images. The analyses did not demonstrate an association between tricuspid annulus displacement and severe right ventricular failure (univariate C-statistics <0.60 for all 4 echocardiographic measures). The discrimination ability was not significantly better than strain (DeLong test p = 0.44) and modified tricuspid annular plane systolic excursion (p = 0.89). The discrimination ability of tricuspid annulus displacement measurements was not better than the Michigan risk score (p = 0.65) and pulmonary artery pulsatility index (p = 0.73).ConclusionsIntraoperative echocardiographic parameters, including tricuspid annulus displacement, modified tricuspid annular plane systolic excursion, and strain, are poor discriminators of severe right ventricular failure after left ventricular assist device implantation. The preoperative Michigan risk-scoring system and intraoperative pulmonary artery pulsatility index are equally unreliable.Copyright © 2019 Elsevier Inc. All rights reserved.

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