Abstract
The main aim was a systematic evaluation of the current evidence on outcomes for patients undergoing right ventricular assist device (RVAD) implantation following left ventricular assist device (LVAD) implantation. This systematic review was registered on PROSPERO (CRD42019130131). Reports evaluating in-hospital as well as follow-up outcome in LVAD and LVAD/RVAD implantation were identified through Ovid Medline, Web of Science and EMBASE. The primary endpoint was mortality at the hospital stay and at follow-up. Pooled incidence of defined endpoints was calculated by using random effects models. A total of 35 retrospective studies that included 3260 patients were analyzed. 30 days mortality was in favour of isolated LVAD implantation 6.74% (1.98-11.5%) versus 31.9% (19.78-44.02%) p = 0.001 in LVAD with temporary need for RVAD. During the hospital stay the incidence of major bleeding was 18.7% (18.2-19.4%) versus 40.0% (36.3-48.8%) and stroke rate was 5.6% (5.4-5.8%) versus 20.9% (16.8-28.3%) and was in favour of isolated LVAD implantation. Mortality reported at short-term as well at long-term was 19.66% (CI 15.73-23.59%) and 33.90% (CI 8.84-59.96%) in LVAD respectively versus 45.35% (CI 35.31-55.4%) p ⩽ 0.001 and 48.23% (CI 16.01-80.45%) p = 0.686 in LVAD/RVAD group respectively. Implantation of a temporary RVAD is allied with a worse outcome during the primary hospitalization and at follow-up. Compared to isolated LVAD support, biventricular mechanical circulatory support leads to an elevated mortality and higher incidence of adverse events such as bleeding and stroke.
Highlights
Implantable mechanical circulatory devices, such as left ventricular assist device (LVAD), have emerged as a relevant option for improving quality of life and survival in patients with end-stage heart failure and are commonly utilized
A total of 242 full-text records were excluded for the following reasons: no differentiation between the LVAD and LVAD/right ventricular assist device (RVAD) procedure (n = 21), double publication (n = 3), case report (n = 1), surgical technique (n = 3), follow-up not completed (n = 56), studies under defined cut-off (n = 90) and other (n = 68) (Figure 1)
10 comparator studies were analysed, along with a further nine studies dealing with the LVAD procedure and six studies with the LVAD/RVAD procedure
Summary
Implantable mechanical circulatory devices, such as left ventricular assist device (LVAD), have emerged as a relevant option for improving quality of life and survival in patients with end-stage heart failure and are commonly utilized. The most common indications include bridge to transplant, bridge to candidacy, destination therapy and bridge to recovery.[1] Technological developments have led to the use of continuous flow devices, which are superior to previous pulsatile models with regard to efficiency, size, implantability, extended support and overall patient outcomes. Results of clinical practice have led to an expanded role of LVAD in clinical use.[2,3,4] LVAD implantation improves exercise tolerance and endorgan dysfunction and can improve hemodynamics.[5 ] Perfusion 00(0)
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