Abstract 11930: Late Right Heart Failure During Continuous-Flow Left Ventricular Assist Device Support Adversely Affects Post-Transplant Outcome

Abstract

Background: Right heart failure (RHF) is an unresolved issue during continuous-flow left ventricular assist device (LVAD) support. There are scarce data about post-transplant outcomes in patients complicated with late RHF during LVAD support. Objective: To assess whether development of late RHF during LVAD support adversely affected post-transplant survival. Methods: Between May 2004 and December 2013, 141 patients underwent cardiac transplantation after isolated LVAD support as a bridge to transplant at our center. Late RHF was defined as HF requiring medical interventions >4 weeks after LVAD implantation. During the same study period, 3 patients were bridged to transplant with concurrent right ventricular assist device (RVAD) support. Results: The mean age of the study cohort was 54 ± 13 years, 81% were male, and 35% had an ischemic etiology. The mean duration of LVAD support before transplantation was 270 days. Twenty-three patients (16%) developed late RHF during waiting period. Of these, 6 required repeated readmissions due to RHF and 12 were supported with inotropic agents at the time of transplantation. Those patients were more likely to have higher creatinine (1.3 ± 0.67 vs. 1.6 ± 0.86, p = 0.08), higher blood urea nitrogen (23 ± 10 vs. 32 ± 16, p = 0.0019), and lower albumin (4.1 ± 0.47 vs. 3.8 ± 0.59, p = 0.0019) levels at the time of transplantation compared to patients who did not develop RHF. Overall post-transplant survival rate were 87%, 83%, 77% at 1, 3, and 5 years, respectively. The 3-year post-transplant survival was significantly worse in patients who developed late RHF (Figure: 87% vs. 61%, p<0.0001). There were no early and late deaths in patients with RVAD support. Conclusions: Patients who develop late RHF during LVAD support have diminished post-transplant survival. The initiation of RVAD support may be warranted to improve renal function and nutrition status for these high-risk patients.