Evolution of Late Right Heart Failure With Left Ventricular Assist Devices and Association With Outcomes

• Published in: Journal of the American College of Cardiology Vol. 78; no. 23; pp. 2294 - 2308
• Main Authors: Rame, J Eduardo, Pagani, Francis D, Kiernan, Michael S, Oliveira, Guilherme H, Birati, Edo Y, Atluri, Pavan, Gaffey, Ann, Grandin, E Wilson, Myers, Susan L, Collum, Craig, Kormos, Robert L, Kirklin, James K, Teuteberg, Jeffrey J
• Format: Journal Article
• Language: English
• Published: United States 07-12-2021
• Subjects: Databases, Factual; Female; Follow-Up Studies; Heart Failure - epidemiology; Heart Failure - etiology; Heart Failure - physiopathology; Heart-Assist Devices - adverse effects; Humans; Incidence; Male; Middle Aged; Registries; Retrospective Studies; Risk Factors; United States - epidemiology; Ventricular Function, Right - physiology; United States; mechanical circulatory support; right heart failure; ventricular assist; quality of life; outcomes
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2021.09.1362

A revised definition of right heart failure (RHF) for the Society of Thoracic Surgeons Intermacs database of left ventricular assist devices (LVADs) was introduced in June 2014.
The purpose of this study was to determine the prevalence and severity of RHF over time and the association of RHF status at 3 months with 12-month outcomes after LVAD.
All patients in Society of Thoracic Surgeons Intermacs with follow-up and supported at least 3 months with a continuous flow LVAD implanted between June 2, 2014 and March 31, 2017 without a simultaneous RVAD. RHF was defined as both documentation and manifestations of elevated central venous pressures.
There were 6,118 patients included with an incidence of RHF at 3, 6, and 12 months postimplant categorized as mild in 5%, 6%, and 6% and moderate in 5%, 3%, and 3%, respectively. For those with no RHF at 3 months, there was a low incidence of subsequent RHF at 6 and 12 months. The lack of RHF at 3 months, compared with mild and moderate RHF, was associated with a lower 12-month cumulative incidence of mortality (6.9% vs 16.7% vs 28.1%; P < 0.0001) and a lower 12-month cumulative incidence of stroke (7.4% vs 9.5% vs 11.0%; P = 0.0095), gastrointestinal bleeding (14.8% vs 24.2% vs 23.6%; P < 0.0001), and rehospitalization (65.2% vs 73.2% vs 71.2%; P < 0.0001).
In patients surviving 3 months with LVAD support alone, mild or moderate RHF occurred in nearly 1 of 10 patients at 12 months. Patients with late RHF had worse survival and a higher cumulative incidence of major adverse events.