Magnitude of Bleeding and Blood Product Utilization Predict Early Right Ventricular Implantation in LVAD Recipients

Abstract

Purpose We assessed the impact of blood loss and transfusion volume on right ventricular failure (RVF) requiring right-sided mechanical circulatory support (R-MCS) after continuous flow left ventricular assist device (CF-LVAD) implantation. Methods Retrospective review of 434 patients with CF-LVAD implantation from 2003 to 2017. Intraoperative blood loss, postoperative blood loss, and intraoperative transfusion volume was assessed for patients requiring R-MCS. Results Mean patient age was 55.2±13.6 years. Heartware HVAD was inserted in 100 (23.0%) and HeartMate II in 334 (77.0%) patients. Of these, 49 (11.3%) patients required R-MCS. R-MCS placed within 24 hours of CF-LVAD (N=20, 4.6%) had significantly more intraoperative and postoperative blood loss, and received a significantly higher quantity of intraoperative blood products compared to patients who did not require R-MCS within 24 hours (Table 1). HeartMate II patients had higher 24 hour blood loss (3398.3±3721.6 vs 1621.2±1243.4 ml, p Conclusion Intraoperative and postoperative blood loss as well as intraoperative transfusions were associated with development of early RVF requiring R-MCS. This highlights the importance of reducing coagulopathy and its associated need for transfusions in patients at risk for early R-MCS.