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JCU 2017 June;25(2) :39-46.
Published online 2017 June 30. doi:https://doi.org/10.4250/jcu.2017.25.2.39
Systematic Left Ventricular Assist Device Implant Eligibility with Non-Invasive Assessment: The SIENA Protocol
Matteo Cameli, MD, Ferdinando Loiacono, MD, Stefania Sparla, MD, Marco Solari, MD, Elisabetta Iardino, MD, Giulia Elena Mandoli, MD, Sonia Bernazzali, MD, Massimo Maccherini, MD, and Sergio Mondillo, MD
Department of Cardiovascular Diseases, University of Siena, Siena, Italy
Corresponding Author: Ferdinando Loiacono ,Tel: +39-0577-585377, Fax: +39-0577-585377, Email: ferdinando.loiaco@student.unisi.it
ABSTRACT
In patients with end-stage left ventricular (LV) heart failure who receive LV assist device (LVAD) implantation, right ventricular (RV) failure represents a possible critical complication that heavily affects morbidity and mortality. Several clinical, laboratory, hemodynamic, and echocardiographic variables have been found to be associated with RV failure occurrence after surgery. Different models and risk scores have been proposed, with poor results. No accordance has ever been reached about RV pre-operative evaluation, and time has come to introduce a standardized systematic protocol for LVAD suitability assessment according to RV function. We analyzed imaging parameters associated with LVAD implantation-related RV failure, in order to identify the minimum number for pre-operative reliable prediction of post-operative RV failure. A few echocardiographic parameters have been identified as the most reliable, or promising, and reproducible tools in this field: free-wall RV longitudinal strain, RV fractional area change, RV sphericity index, and RV ejection fraction with 3D-echocardiography. We propose the Systematic LVAD Implant Eligibility with Non-invasive Assessment protocol–the SIENA protocol–as a new and simple way of pre-operative evaluation of patients candidates to LVAD implantation.
Keywords: Right ventricle · Heart failure · Left ventricular assist device · Strain · Echocardiography.
Volume 25, No 2
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