Impact of left ventricular assist device implantation on right and left ventricular volumes and functions

Background Because the right ventricle is not assisted, its function is a critical determinant of the hemodynamic inpatients with left ventricular (LV) assist devices (LVADs) and contributes significantly to postoperative morbidity and mortality. Right ventricular (RV) failure remains a challenge in the area of continuous-flow LVADs. The aim of this study was to evaluate the evolution of RV volumes and function before and after LVAD implantation. Methods Ten patients underwent tomographic equilibrium radionuclide ventriculography for the assessment of LV and RV volumes and functions before and after LVAD implantation. Results Mean LV and RV ejection fractions before implantation were 20 ± 8 and 46 ± 14%, respectively. LVAD implantation had no impact on RV ejection fraction (46 ± 11% after implantation, P = 0.961) but tended to increase LV ejection fraction (31 ± 21% after implantation, P = 0.09). LVAD led to a decrease of LV end-diastolic volume (Δ = −136 ± 96 after implantation, P = 0.001) and RV end-diastolic volume (Δ = −59 ± 49 after implantation, P = 0.004) ( Fig. 1 ). Conclusion Inpatients with preserved RV ejection fraction, LVAD implantation leads to a decrease of RV volumes without impact on RV ejection fraction. The increase of cardiac output induced by the LVAD does not increase RV volumes, which could be explained by the decrease of RV after load. These results highlight the importance of after load on the right ventricle inpatients with heart failure.