A multi-institutional retrospective analysis on impact of RV acute mechanical support timing after LVAD implantation on 1-year mortality and predictors of RV acute mechanical support weaning

Salil Kumar, Mohamed H. Derbala, Duc T. Nguyen, Joel Ferrall, Matthew Cefalu, Mercedes Rivas-Lasarte, Syed Muhammad Ibrahim Rashid, Denny T. Joseph, Edward A. Graviss, Daniel Goldstein, Ulrich P. Jorde, Arvind Bhimaraj, Erik E. Suarez, Sakima A. Smith, Daniel B. Sims, Ashrith Guha

Research output: Contribution to journalArticlepeer-review

Abstract

Background: There is little insight into which patients can be weaned off right ventricular (RV) acute mechanical circulatory support (AMCS) after left ventricular assist device (LVAD) implantation. We hypothesize that concomitant RV AMCS insertion instead of postoperative implantation will improve 1-year survival and increase the likelihood of RV AMCS weaning. Methods: A multicenter retrospective database of 826 consecutive patients who received a HeartMate II or HVAD between January 2007 and December 2016 was analyzed. We identified 91 patients who had early RV AMCS on index admission. Cox proportional-hazards model was constructed to identify predictors of 1-year mortality post-RV AMCS implantation and competing risk modeling identified RV AMCS weaning predictors. Results: There were 91 of 826 patients (11%) who required RV AMCS after CF-LVAD implantation with 51 (56%) receiving a concomitant RV AMCS and 40 (44%) implanted with a postoperative RV AMCS during their ICU stay; 48 (53%) patients were weaned from RV AMCS support. Concomitant RV AMCS with CF-LVAD insertion was associated with lower mortality (HR 0.45 [95% CI 0.26-0.80], p = 0.01) in multivariable model (which included age, BMI, angiotensin-converting enzyme inhibitor use, and heart transplantation as a time-varying covariate). In the multivariate competing risk analysis, a TPG < 12 (SHR 2.19 [95% CI 1.02-4.70], p = 0.04) and concomitant RV AMCS insertion (SHR 3.35 [95% CI 1.73-6.48], p < 0.001) were associated with a successful wean. Conclusions: In patients with RVF after LVAD implantation, concomitant RV AMCS insertion at the time of LVAD was associated with improved 1-year survival and increased chances of RV support weaning compared to postoperative insertion.

Original languageEnglish (US)
Pages (from-to)244-254
Number of pages11
JournalJournal of Heart and Lung Transplantation
Volume41
Issue number2
DOIs
StatePublished - Feb 2022

Keywords

  • left ventricular assist device
  • mechanical circulatory support
  • mechanical circulatory support complications
  • right ventricular assist device
  • right ventricular failure
  • shock

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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