Contemporary outcome of unplanned right ventricular assist device for severe right heart failure after continuous-flow left ventricular assist device insertion

• Published in: Interactive cardiovascular and thoracic surgery Vol. 24; no. 6; pp. 828 - 834
• Main Authors: Yoshioka, Daisuke, Takayama, Hiroo, Garan, Reshad A., Topkara, Veli K., Han, Jiho, Kurlansky, Paul, Yuzefpolskaya, Melana, Colombo, Paolo C., Naka, Yoshifumi, Takeda, Koji
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-06-2017
• Subjects: Female; Heart Failure - mortality; Heart Failure - physiopathology; Heart Failure - surgery; Heart-Assist Devices; Humans; Male; Middle Aged; Retrospective Studies; Severity of Illness Index; Survival Rate - trends; United States - epidemiology; Ventricular Function, Right; RVAD; Right heart failure; Continuous-flow LVAD
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivw409

Abstract
OBJECTIVES: The timely use of a right ventricular assist device (RVAD) becomes necessary for severe right heart failure (RHF) after left ventricular assist device (LVAD) insertion. This study evaluates outcomes in patients who required unplanned RVAD support early after continuous-flow (CF) LVAD insertion.
METHODS: We retrospectively reviewed 305 patients who underwent HeartMate II/HeartWare CF-LVAD insertion between 2009 and 2014. Twenty-seven (9%) patients required unplanned RVAD for severe RHF early after LVAD insertion. We compared early and late outcomes in patients with and without RVAD.
RESULTS: The median time to RVAD implantation after primary CF-LVAD implantation was 1.0 (0–3) day. Seventeen (63%) patients could be weaned from RVAD after median of 14 (10–18) days. In 278 patients in the isolated LVAD group, overall survival at 3 and 12 months was 95% and 86%, whereas 59% and 54% in the unplanned RVAD group, respectively (P < 0.001). The 12-month overall survival rate in patients who were weaned from RVAD was 75% (P = 0.189 vs isolated LVAD group), whereas in patients who could not be weaned from RVAD, the overall survival was 20% (P < 0.001 vs RVAD weaning group and isolated LVAD group). Readmission free rate for RHF at 1 year was 53% in the unplanned RVAD group and 90% in the isolated LVAD group (P = 0.002).
CONCLUSIONS: Among patients who required unplanned RVAD after CF-LVAD implantation, above 60% of the patients could be weaned from RVAD. However, careful attention should be paid to the recurrent or sustained RHF.