Predictors of Early Unplanned RVAD Use in Patients Undergoing 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 preoperative predictors of RVAD use within only 48 hours of LVAD implantation. Methods We studied 343 patients who underwent continuous-flow LVAD implantation at a single center. Forty-eight (14%) received unplanned temporary RVAD support within 48 hours following LVAD placement. Multivariate logistic regression was used to identify independent predictors for the need of early RVAD support. Results Patients who required early temporary RVAD support had significantly different preoperative clinical characteristics compared to those who did not require support, including a younger age (53 vs. 58 years, respectively), a higher proportion of women (33% vs. 18%, respectively) and higher risk INTERMACS Profile of 1 or 2 (50% vs. 15%, respectively; p 2-fold risk-increase); INTERMACS Profile 1 or 2 (>4-fold risk-increase); the need for IABP or ECMO before LVAD implantation (>3-fold risk-increase); and increased AST levels (4% risk-increase per 10-unit increment). Conclusion Preoperative predictors of temporary, unplanned RVAD use within 48 hours of LVAD implantation include clinical and laboratory markers of hemodynamic instability and end-organ dysfunction. Female gender is a risk factor for RVAD use in this analysis and requires further study in a larger cohort.