Home Inotropic Therapy Post Left Ventricular Assist Device Placement

• Published in: The Journal of heart and lung transplantation Vol. 38; no. 4; p. S228
• Main Authors: Pauwaa, S., Meehan, K., Kukla, L., Krause, N., Aicher, T., Macaluso, G., Andrade, A., Joshi, A., Sciamanna, C., Dia, M., Pappas, P., Tatooles, A., Cotts, W.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2019
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2019.01.559

Left ventricular assist device (LVAD) therapy improves survival and quality of life in patients with advanced systolic heart failure. Right heart failure (RHF) is not uncommon following LVAD implantation and is associated with poor prognosis. Management of RHF post LVAD often involves inotropic therapy. Refractory RHF may require discharge on home inotropes. Outcomes in LVAD patients discharged on inotropic therapy has not been well studied. We report our experience with LVAD patients discharged home on inotropic therapy. We retrospectively reviewed 520 durable LVAD implants at our center between 1/1/13 and 4/1/18. All patients discharged on home inotropic therapy following LVAD implantation were included. Age, device type, duration of inotropic therapy, infection, ICD shocks, rehospitalizations, and outcomes were recorded. 39 LVAD patients were discharged on inotropic therapy and included in this analysis. The average age was 56.7±13.6 years. 31 (79%) were male. 20 (51%) patients were implanted as destination therapy (DT). We included 16 (41%) patients with HeartWare LVADs and 28 with HeartMate2 LVADs. Average time on device support was 950±523 days. Average time on inotropes was 319±236 days. 6 patients (15%) had initiation of inotropes during index admission (early RHF), while the remaining patients had late RHF. Average time from implant to initiation of inotropes was 474±453 days. 18 (46%) patients developed PICC line site infections and 29 (74%) patients developed bacteremia. 21 (54%) patients developed driveline infections. There was a total of 246 readmissions following inotrope initiation. 18 (46%) patients received ICD shocks while on inotropic therapy. 11 (28%) patients died on inotropes at an average of 325±251 days from initiation of inotropes with RHF being the primary cause of death in 9 (81%) patients. Nine (23%) patients underwent successful heart transplantation. Home inotropic therapy following LVAD implantation is associated with significant risk. Infections, including PICC line infections and bacteremia occurred at high rates. Late RHF was more common than early RHF. Overall, there is a high morbidity and mortality associated with home inotropic therapy post-LVAD. Further analysis of post-LVAD care may provide insight regarding opportunities to avoid late RHF given the lack of viable options for its management.