• Taro Shiga, Koichiro Kinugawa, Teruhiko Imamura, Naoko Kato, Miyoko Endo, Toshiro Inaba, Hisataka Maki, Masaru Hatano, Atsushi Yao, Takashi Nishimura, Yasunobu Hirata, Shunei Kyo, Minoru Ono, and Ryozo Nagai.
• Department of Cardiovascular Medicine, University of Tokyo Hospital, Tokyo, Japan.
• Circ. J. 2012 Jan 1;76(12):2785-91.

BackgroundPatients with biventricular assist device (BiVAD) placement have a poor prognosis, but preoperative risk factors for the necessity of BiVAD have not been fully elucidated.Methods And ResultsData from 79 patients who received left ventricular assist device (LVAD) between November 2002 and December 2011 were retrospectively reviewed. Overall, 9 patients (11.4%) required BiVAD, and the survival rate of BiVAD patients was significantly lower than that of LVAD patients (P<0.001). Multivariate analysis for BiVAD requirement showed left ventricular diastolic diameter (LVDd) ≤62 mm (odds ratio [OR], 10.97; P=0.009) to be significantly associated with BiVAD requirement. Preoperative central venous pressure (CVP)/pulmonary capillary wedge pressure (PCWP) ratio ≥0.5 (OR, 13.09; P=0.028) was also significantly associated with BiVAD requirement. A new scoring system for predicting BiVAD requirement was created from the combination of CVP/PCWP ratio (≥0.5), body surface area (≤1.4 m(2)), preoperative continuous hemodiafiltration use, B-type natriuretic peptide (≥1,200 pg/ml) and LVDd (≤62 mm), and this had a significantly larger area under the curve (0.909; P=0.003) than right ventricular stroke work index on receiver operating characteristic analysis. A score >20 using the new scoring method indicated significantly high probability of BiVAD requirement (OR, 16.00; P=0.019).ConclusionsThe new scoring method, which includes CVP/PCWP ratio, is a novel risk stratification tool for BiVAD therapy.

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