medical decision support medical decision support
Sign In

Predictors of Kormos et al for Right Ventricular Failure in a Patient with the HeartMate II Left Ventricular Assist Device (LVAD)

Description

Kormos et al identified factors predictive of right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device (LVAD). A patient at risk may benefit from preoperative optimization of right heart failure and/or biventricular support. The authors are from multiple institutions in the United States.


Patient selection: HeartMate II continuous-flow LVAD as bridge to heart transplantation

 

Parameters:

(1) ratio of central venous pressure (CVP) to pulmonary capillary wedge pressure (PCWP)

(2) need for preoperative ventilator support

(3) serum BUN > 39 mg/dL

 

Parameter

Finding

Odds Ratio

CVP to PCWP ratio

<= 0.63

1

 

> 0.63

2.3

preoperative ventilatory support

no

1

 

yes

5.5

serum BUN

<= 39 mg/dL

1

 

> 39 mg/dL

2.1

 

cumulative odds ratio =

= PRODUCT(odds ratios for the 3 risk factors)

 

Interpretation:

• minimum product: 1

• maximum product: 26.57

• The higher the cumulative product the greater the risk for right ventricular failure.

• A patient with right ventricular failure has worse overall survival, longer cardiopulmonary bypass times, greater need for reoperation and greater transfusion needs.


To read more or access our algorithms and calculators, please log in or register.

Specialty