Late Right Heart Failure after Left Ventricular Assist Device Implantation: Characteristics, Predictors, and Outcomes

• Published in: Journal of cardiac failure Vol. 26; no. 10; p. S136
• Main Authors: Alkhunaizi, Fatimah A., Gulati, Arune, Muslem, Rahat, Tedford, Ryan J., Choi, Chun W., Kilic, Ahmet, Florido, Roberta, Gilotra, Nisha, Sharma, Kavita, Hsu, Steven
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.10.2020
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2020.09.396

Late right heart failure (LRHF) in patients with left ventricular assist device (LVAD) remains inadequately understood. We sought to evaluate characteristics, predictors, and outcomes of patients who develop LRHF following LVAD. We studied a single-center retrospective cohort of 108 consecutive LVAD patients from 2010-2016. Late right heart failure (LRHF) was defined as evidence of elevated right atrial pressure (RAP > 16 mmHg or jugular venous distention), with concomitant peripheral edema, elevated bilirubin or creatinine, occurring 30 days following LVAD implantation. LRHF was excluded if underlying left heart failure was present (e.g. elevated left-sided filling pressures or medication/speed adjustment alleviated symptoms). Seventeen patients (15%) developed LRHF at a median of 60 (IQR 30,150) days after LVAD implantation. LRHF patients demonstrated higher right atrial pressure (14±6 vs 9±4 mmHg, P=0.002) and pulmonary vascular resistance (3.4±1.7 vs 2.5±1.0 WU, P=0.03), without significant difference in wedge pressure (15±6 vs 13±6 mmHg, P=0.15). LRHF patients required significantly higher diuretic doses at 6 months post-LVAD (furosemide equivalent 184±148 vs 60±78 mg/day, P < 0.001). Univariate predictors of LRHF included higher pre-implant BUN (P=0.02), post-implant severe or severe-acute RHF (P=0.02), and higher daily loop diuretic dose at 1-month post-implant (P=0.01). In cumulative incidence regression analysis, which accounts for competing outcomes, LRHF patients demonstrated no significant difference in rate of transplant (P=0.21), but did demonstrate significantly increased mortality rate (P=0.013, see Figure). The latter remained true independent of device implant indication. LRHF is a relatively rare complication in LVAD patients. Early post-op RHF and 1-month diuretic requirements predict progression to LRHF. LRHF is associated with increased mortality but no difference in transplant rates.