Long-Term Survival of Patients Requiring Early Temporary RVAD Support Following LVAD Implantation

Abstract

Purpose Severe early right heart failure is a life-threatening complication of left ventricular assist device (LVAD) implantation that may require unplanned temporary right ventricular assist device (RVAD) support. There are limited data on the association between the need for early RVAD support and long-term survival following LVAD implantation. Methods We studied 348 patients who underwent continuous-flow LVAD implantation in a single center Registry. Forty-eight (14%) patients received an unplanned temporary RVAD within 48 hours following LVAD implantation. Multivariate Cox proportional hazards regression modeling was used to assess long-term mortality in patients who did vs. did not receive a RVAD. Results Patients (mean age 57 years, 80% male) were supported by a LVAD for a mean of 2.5 years, and 137 (39%) patients died during the follow-up period. Multivariate analysis showed that RVAD use was associated with a significant 3-fold increase in the risk of short-term (6-month) mortality (HR 2.99 [95% CI: 1.39-6.43]). However, among early RVAD patients who survived to 6 months, the risk for subsequent long-term mortality was significantly reduced (HR 0.41 [95% CI 0.14-1.14]; p value for the difference in mortality-risk associated with early RVAD support before and after 6 months = 0.002 [figure]). Conclusion Temporary, unplanned RVAD use within 48 hours of LVAD implantation is independently associated with increased short-term (6-month) mortality. However, the mortality risk associated with the need for RVAD support is significantly attenuated thereafter during long-term follow-up.