(970) Comparison of Different Temporary RVAD Systems in Patients Undergoing LVAD Implantation

• Published in: The Journal of heart and lung transplantation Vol. 42; no. 4; p. S418
• Main Authors: Opacic, D., Klüß, C., Becker, T., Rudloff, M., Lauenroth, V., Deutsch, M., Costard-Jäckle, A., Fox, H., Schramm, R., Morshuis, M., Gummert, J., Rojas, S.V.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-04-2023
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2023.02.1081

Acute right ventricular failure is one of the most dreaded complications following left ventricular assist device (LVAD) implantation. The most established treatment for this disease pattern is the implantation of a temporary paracorporeal right ventricular assist device (RVAD). Currently, in our institution, three different ECLS pump configurations are established and randomly deployed based on their availability. We sought to assess differences between these three systems regarding mortality, bleeding complications, and postoperative length of stay at the intensive care unit.
The study was designed as a monocentric, retrospective case-control study. All patients receiving LVAD with paracorporeal RVAD between 2009 and 2020 were included, and three patient groups were formed (A: Centrifugal pump, B: Rotary pump, C: Compact pump).
A total of 245 patients were included. Preoperative parameters were similar between the A and B groups, but the C group patients were worse with a lower INTERMACS Score (A: 1.7±0.8 vs. B: 1.9±0.9 vs. C: 1.4±0.5, p<0.01). Postoperative mortality was similar between the groups (A: 87 (59.6%) vs. B: 38 (71.7%) vs. C: 32 (69.6%); p<0.20). Major bleeding complications were the most common in the Rotary pump group (A: 32 (21.9%) vs. B: 25 (47.2%)† vs. C: 8 (17.4%); p<0.01). This was associated with increased thrombocyte and erythrocyte transfusions (A: 54.8±48.2 vs. B: 73.1±47.3 vs. C: 46.5±39.5; p<0.01 and A: 20.0±18.7 vs. B: 32.3±27.7 vs. C: 17.9±15.4; p<0.01; respectively). Consecutively, these patients stayed longer at the intensive care unit (A: 47.3 95%CI(40.5-54.1) vs. B: 68.8 95%CI(49.4-88.3) vs. C: 54.3 95%CI(40.0-68.7); p<0.05).
The temporary RVAD is associated with bleeding complications and has an impact on overall outcomes. Our data suggest that different ECLS configurations can significantly influence these complications. Frequent major bleeding complications in the Rotary pump group could stem from increased thrombocyte decline due to the high revolution rates inherent to the rotary pump design. Despite being a retrospective study dealing with highly complex, multimorbid patients, our study shows relevant observations that should be considered and confirmed either in experimental or multicentre studies.