Late right heart failure during support with continuous-flow left ventricular assist devices adversely affects post-transplant outcome

Abstract

Right heart failure (RHF) is an unresolved issue during continuous-flow left ventricular assist device (LVAD) support. Little is known about post-transplant outcomes in patients complicated by late RHF during LVAD support. Between May 2004 and December 2013, 141 patients underwent cardiac transplantation after isolated LVAD bridging at our center. Late RHF was defined as heart failure requiring medical intervention >4 weeks after LVAD implantation. The patients' mean age was 53 ± 13 years, 82% were men, and 36% had an ischemic etiology. The mean duration of LVAD support before transplantation was 0.75 years. Late RHF developed in 21 patients (15%) during LVAD support. Of these patients, 11 were supported with inotropic agents at the time of transplantation. Patients with RHF had higher creatinine (1.6 ± 0.88 mg/dL vs 1.3 ± 0.67 mg/dL, p = 0.07), higher blood urea nitrogen (32 ± 17 mg/dL vs 24 ± 10 mg/dL, p = 0.0013), higher total bilirubin (0.96 ± 0.46 mg/dL vs 0.78 ± 0.42 mg/dL, p = 0.07), and lower albumin (3.8 ± 0.60 g/dL vs 4.1 ± 0.46 g/dL, p = 0.0019) at the time of transplantation compared with patients who did not develop RHF. In-hospital mortality was significantly higher in patients with late RHF during LVAD support (29% vs 6.7%, p = 0.002). Overall post-transplant survival rates were 87% at 1 year, 83% at 3 years, and 77% at 5 years. The 5-year post-transplant survival was significantly worse in patients who developed late RHF during LVAD support compared with survival in patients who did not develop RHF (26% vs 87%, p < 0.0001). Late RHF during LVAD support adversely affects post-transplant survival.