Comparison of Outcomes between Permanent and Temporary Right Ventricular Assist Devices Following Left Ventricular Assist Device Implantation

Abstract

Purpose Right heart failure (RHF) affects 20-30% of left ventricular assist device (VAD) recipients, and is a major cause of morbidity and mortality. We hypothesized that the benefits of temporary right VADs (tRVADs) may be overestimated, and insertion of a planned permanent right VAD (pRVAD) may have better survival, reduced morbidity, and reduced re-admission rates. Methods Retrospective analysis was performed on 116 consecutive patients undergoing LVAD insertion at The Alfred Hospital, Australia between 2011 to 2018, utilizing retrospective and prospectively collected data. Results Of the 116 LVAD patients, 32 received either a tRVAD (n=22) or pRVAD (n=10) at the time of LVAD implant. Of the 22 tRVAD patients, 9 were not able to be weaned. Four died, and 5 (22.7%) were converted to a permanent device. There was no significant difference in survival to discharge whether a permanent or temporary RVAD was primarily implanted (pRVAD 90%, tRVAD 81.8%; p = 0.56). Patients who were discharged following a successful tRVAD wean - that is no right-side device on discharge - had more readmission days for heart failure, compared with those discharged with a pRVAD (0.5 days [95%CI 0 - 10] vs 0 days [95%CI 0 - 0], respectively; p = 0.014). Conclusion Temporary RVAD support, although attractive as a low cost option, is associated with more heart failure readmissions in LVAD patients compared to those discharged on biventricular VAD support.