340 - Severity of Right Heart Failure Post LVAD Implantation Predicts 1 Year Mortality

Abstract

Background: The presence of right ventricular failure (RVF) following LVAD implantation has been identified as a predictor of mortality. Our goal was to investigate whether the severity of RVF using INTERMACS criteria was a better method to determine 1-year mortality post LVAD implantation. Methods: We performed a single-center retrospective analysis of 211 patients who received a Heartmate II LVAD between Jan 1st 2007 and Dec 31st 2014. RVF severity using INTERMACS criteria was determined prior to LVAD implantation. These patients were stratified into no RVF, mild RVF, moderate RVF, and severe RVF. Survival analysis was completed to determine if the severity of RVF was associated with 1-year mortality. Results: 54 patients (25%) were found to have RVF after LVAD implantation. Of those, 14 (26%) were found to have mild RVF, 31 (57%) were found to have moderate RVF, and 9 (17%) were found to have severe RVF. INTERMACS profile, total bilirubin, creatinine, and mean RAP were significantly different between severity classifications. Univariate analysis demonstrated that moderate and severe RVF were associated with 1-year mortality (log rank p = .0001). Furthermore, multivariate analysis (adjusting for age, gender, creatinine, and INTERMACS profile) demonstrated that moderate RVF (HR 3.68, P < .0001, 95% CI [1.88–7.19]) and severe RVF (HR 7.24, P = .001, 95% CI [2.36–22.9]) were significant independent predictors of death. Conclusion: RVF has been recognized as an ominous prognostic marker following LVAD implantation. We have demonstrated that the severity of RVF, rather than presence or absence of RVF, is a better predictor of 1-year mortality, and as such, should be considered when evaluating patients for LVADs.View Large Image Figure ViewerDownload Hi-res image Download (PPT)