The incidence, risk factors, and outcomes associated with late right-sided heart failure in patients supported with an axial-flow left ventricular assist device

• Published in: The Journal of heart and lung transplantation Vol. 36; no. 1; pp. 50 - 58
• Main Authors: Rich, Jonathan D., Gosev, Igor, Patel, Chetan B., Joseph, Susan, Katz, Jason N., Eckman, Peter M., Lee, Sangjin, Sundareswaran, Kartik, Kilic, Ahmet, Bethea, Brian, Soleimani, Behzad, Lima, Brian, Uriel, Nir, Kiernan, Michael
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2017
• Subjects: Cause of Death - trends; death; Equipment Failure; Female; Follow-Up Studies; Heart Failure - diagnosis; Heart Failure - physiopathology; Heart Failure - surgery; Heart Transplantation; Heart-Assist Devices; HeartMate II; Humans; Incidence; late right-sided heart failure; left ventricular assist device; Male; mechanical circulatory support; Middle Aged; outcomes; predictors; Prognosis; Prospective Studies; Risk Assessment; Risk Factors; Survival Rate - trends; Time Factors; United States - epidemiology; Ventricular Dysfunction, Right - diagnosis; Ventricular Dysfunction, Right - physiopathology; Ventricular Dysfunction, Right - surgery; late right-sided heart failure; predictors; death; outcomes; mechanical circulatory support; HeartMate II; left ventricular assist device
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2016.08.010

Early right-sided heart failure (RHF) after left ventricular assist device (LVAD) implantation is associated with increased mortality, but little is known about patients who develop late RHF (LRHF). We evaluated the incidence, risk factors, and clinical impact of LRHF in patients supported by axial-flow LVADs. Data were analyzed from 537 patients enrolled in the HeartMate II (HM II; Thoratec/St. Jude) destination therapy clinical trial. LRHF was defined as the development of clinical RHF accompanied by the need for inotropic support occurring more than 30 days after discharge from the index LVAD implant hospitalization. Clinical variables, quality of life, rehospitalizations, and survival were compared between patients with and without LRHF. LRHF developed in 41 patients (8%), with a median time to LRHF of 480 days. A higher preoperative blood urea nitrogen and increased central venous pressure–to–pulmonary capillary wedge pressure ratio were independent predictors of LRHF. The Michigan and HMII RHF risk scores were both associated with an increased likelihood of LRHF (p < 0.05). Patients with LRHF had worse quality of life according to the Kansas City Cardiomyopathy Questionnaire (61 ± 26 vs 70 ± 21; p < 0.05), poorer functional capacity by 6-minute walk distance (275 ± 189 m vs 312 ± 216 m; p < 0.05), and more rehospitalizations (6 vs 3; p < 0.001). LRHF was associated with decreased survival (p < 0.001). LRHF is an important complication in patients with LVADs and is associated with worse quality of life, reduced functional capacity, more frequent hospitalizations, and worse survival compared with those without LRHF.