Introduction:
Right ventricular failure (RVF) is a common complication after continuous-flow left ventricular assist device (cf-LVAD) and carries an increased risk of mortality. There is a spectrum of early RVF and the optimal definition is controversial, hindering efforts to identify relevant risk factors. Correlating the severity of RVF with outcome after LVAD could inform clinical criteria for this important syndrome.
Hypothesis:
Increasing severity of RVF will be associated with worse one-year survival.
Methods:
We identified 196 patients undergoing isolated durable cf-LVAD since 2005 at our center. Post-implant RVF was graded as absent, mild (requiring inotropes for 14-20 days), moderate (requiring inotropes for ≥ 21 days), or severe (requiring unplanned RVAD at any time during the index hospitalization). One-year survival, censored at the time of heart transplant or VAD explant for recovery, was examined using Kaplan-Meier plots, the log-rank test, and Cox proportional-hazard modeling.
Results:
Seventy-three patients (37.2%) developed RVF: 35 (17.9%) mild, 24 (12.2%) moderate, and 14 (7.1%) severe. The median follow-up time was 266 days (IQR: 81-761), and 51 patients (26%) died within one year. Compared to patients without RVF, those with mild RVF had similar one-year survival (HR 0.69, 95%CI:0.26-1.80, p=0.45) while the risk of death was substantially increased in patients with moderate (HR 2.65, 95%CI:1.27-5.54, p=0.009) and severe RVF (HR 8.16, 95%CI:3.97-16.76, p<0.0001). The severity of RVF was strongly associated with one-year mortality, which persisted in multivariate modeling (Figure).
Conclusions:
A simple grading system for the severity of early RVF is strongly associated with one-year survival after cf-LVAD, supporting the notion that there is a spectrum of post-implant RVF. If confirmed in other cohorts, targeting risk-prediction and risk-mitigation strategies for moderate and severe RVF could improve post-LVAD survival.
One-year experience with the LionHeart fully implantable left ventricular assist device
