Continuous-flow left ventricular assist devices (CF-LVADs) are central to advanced heart failure management but are complicated by right ventricular failure (RVF) in up to 40% of patients, increasing morbidity and mortality and underscoring the need for robust prediction tools. We performed a single-center retrospective study of CF-LVAD recipients from March 2009 to May 2024. Of 326 patients, 205 met inclusion criteria; RVF was defined as need for inotropes or right ventricular assist device support. We compared established RVF risk scores (Michigan, Penn/Fitzpatrick, European Registry for Patients with Mechanical Circulatory Support [EUROMACS], Central venous pressure, severe Right ventricular dysfunction, preoperative Intubation, severe Tricuspid regurgitation, Tachycardia [CRITT]) using receiver operating characteristic analysis, logistic regression, and internal validation. Among 205 patients, 81 (39.5%) developed post-LVAD RVF. The EUROMACS score had the highest predictive value ( C -statistic 0.670, P < .001), followed by CRITT (0.653, P < .001), Penn (0.616, P = .004), and Michigan (0.606, P = .005). Youden-optimized cutoffs were derived to summarize sensitivity, specificity, positive predictive value, and negative predictive value. Mortality analysis was performed as a secondary exploratory endpoint. Overall, discrimination of existing RVF scores remained modest. EUROMACS performed best but highlighted the need to refine models with contemporary hemodynamic and echocardiographic metrics and to pursue rigorous external validation.

The use of continuous flow left ventricular assist device (CF-LVAD) has revolutionized the management of advanced heart failure. One of the major complications associated with its use is the risk of bleeding, especially in the early postoperative period. Early events of postoperative bleeding have been associated with higher morbidity and mortality rates. Our study aims at identifying potential predictors of intraoperative bleeding, defined as 4 or more units of packed red blood cells transfused during surgery. A single-center retrospective cohort study of adult patients older than 18 years old who underwent CF-LVAD implantation between 2009 and 2024. Data were collected for the duration of implant hospitalization, including perioperative invasive hemodynamics, echocardiography, operative details, mechanical circulatory support, antiplatelets, inotropes, bleeding events, and blood product use, in addition to patient history and baseline characteristics. A total of 208 patients were included in the analysis. Intraoperative bleeding occurred in 43 (20.67%) patients while 165 (79.33%) patients did not experience bleeding. Multilogistic regression analysis showed that artery bypass grafting pre-LVAD (odds ratio [OR] 2.98, confidence interval [CI] 1.2-7.42, p = 0.01) and temporary mechanical assist device pre-LVAD (OR 3.67, 95%CI 1.72-7.85, p < 0.001) were independent predictors of intraoperative bleeding during hospitalization. Intraoperative bleeding is also correlated with worse clinical outcomes, higher 90-day mortality (hazard ratio [HR] 10.4, p < 0.01, CI 95% 3.28-33.38) 206 subjects with 14 failures. History of coronary artery bypass grafting and mechanical circulatory support before the implantation of LVAD are independent predictors of intraoperative bleeding during hospitalization in these patients. Intraoperative bleeding is associated with higher frequency of right ventricle failure post-LVAD and higher 90-day mortality.