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The Safety of Right Heart Catheterization in Patients with Continuous-Flow Left Ventricular Assist Devices

      Background

      Right heart catheterization (RHC) is a crucial tool in the management of patients with continuous-flow left ventricular assist devices (CF-LVADs). Patients with CF- LVADs are known to have an acquired von Willebrand syndrome and receive additional anticoagulation. The aim of this study is to evaluate the practice and safety of RHC in patients with CF-LVADs.

      Methods

      A retrospective analysis of patients with CF-LVADs undergoing simultaneous RHC and ramp studies at a large academic medical center from April 2014 to March 2015 was performed. Baseline characteristics, INR prior to procedure, catheterization site, and complications of procedure were examined.

      Results

      Thirty-three patients underwent concurrent RHC and ramp studies (HMII: n = 19, HVAD: n = 14). These patients were mostly male (63.6%), 58.7 ± 9.6 years old, and BMI 29.9 ± 8.6 kg/m2. RHC and ramp study was performed 465 ± 498 days after device implantation. The average INR prior to speed adjustment was 2.0 ± 0.4. Ultrasound guidance was used for initial access with a micropuncture needle before upsizing to a 7 French sheath. The right internal jugular vein was used for hemodynamic monitoring in all patients except one in which there was noted to be thrombus and the left internal jugular vein was then cannulated. Patients with an INR < 1.8 were given heparin intravenously at a concentration of 60 units per kilogram after access was obtained. There were no bleeding complications and blood loss was estimated minimal to 15 mL during the procedures.

      Conclusions

      RHC using the internal jugular vein can be safely performed in patients with CF-LVADs.
      Table 1
      INRNumber of PatientsComplications
      <1.540
      1.5-<2100
      2-2.5180
      >2.510