Abstract
The aim of this study was to examine the incidence and significance of right heart failure (RHF) in the early and late phase of left ventricular assist device (LVAD) implantation with the identification of predictive factors for the development of RHF. This was a prospective observational analytical cohort study. The study included 92 patients who underwent LVAD implantation and for whom all necessary clinical data from the follow-up period were available, as well as unambiguous conclusions by the heart team regarding pathologies, adverse events, and complications. Of the total number of patients, 43.5% died. The median overall survival of patients after LVAD implantation was 22 months. In the entire study population, survival rates were 88.04% at one month, 80.43% at six months, 70.65% at one year, and 61.96% at two years. Preoperative RHF was present in 24 patients, 12 of whom died and 12 survived LVAD implantation. Only two survivors developed early RHF (ERHF) and two late RHF (LRHF). The most significant predictors of ERHF development are brain natriuretic peptide (BNP), pre-surgery RHF, FAC < 20%, prior renal insufficiency, and total duration of ICU stay (HR: 1.002, 0.901, 0.858, 23.554, and 1.005, respectively). RHF following LVAD implantation is an unwanted complication with a negative impact on treatment outcome. The increased risk of fatal outcome in patients with ERHF and LRHF after LVAD implantation results in a need to identify patients at risk of RHF, in order to administer the available preventive and therapeutic methods.
Highlights
Due to the limited number of available donors and the limited effectiveness of conservative treatment methods, left ventricular assist devices (LVADs) are widely used today to treat patients with end-stage heart failure [1]
The development of experienced and well-trained teams composed of cardiac surgery and cardiology specialists, LVAD technicians, perfusionists, and nurses reduces the rate of complications following LVAD implantation [4]
right heart failure (RHF) following LVAD implantation is an unwanted complication with a negative impact on treatment outcomes
Summary
Due to the limited number of available donors and the limited effectiveness of conservative treatment methods, left ventricular assist devices (LVADs) are widely used today to treat patients with end-stage heart failure [1]. Good therapeutic results are achieved as a result of the continuous and intensive development of new devices, improvement of surgical techniques, accumulation of experience in implantation, and improved post-implantation clinical management [2,3]. The development of experienced and well-trained teams composed of cardiac surgery and cardiology specialists, LVAD technicians, perfusionists, and nurses reduces the rate of complications following LVAD implantation [4]. The identification of patients at increased risk for post-implantation right heart failure (RHF) is still the subject of intensive research [7]
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