Short and Long Term Mortality in Patients with Right Heart Failure after Left Ventricular Assist Device Placement

Abstract

Introduction The incidence of right heart failure (RHF) after left ventricular assist device (LVAD) placement ranges reportedly from 10-40%. We determined to analyze the short and long term mortality rates for those with RHF after LVAD placement. Methods In a single academic center, we conducted a retrospective analysis of those implanted with a LVAD from 2013 to 2019, and the incidence of postoperative RHF during index admission. Charts with insufficient data were excluded. RHF was defined via the classifications designated by INTERMACS, and patients were categorized into INTERMACS mild, moderate or severe RHF. Cox proportional analysis were performed for Kaplan Meyer curves for 1 and 5-year survival rates. Results A total of 136 LVAD implantations met criteria in which 22.1% were implanted as bridge to transplant and 77.9% as destination therapy. RHF was diagnosed in 44.1% of patients, in which 14.7%, 17.7%, and 11.8% were categorized as INTERMACS mild, moderate, and severe RHF respectively. Ninety-day mortality rates for patients with INTERMACS mild, moderate, and severe RHF were 15%, 10.9%, and 37.5%. The combined 90-day mortality rate for all patients with RHF was 23%. One-year mortality rates (FIGURE 1) for INTERMACS mild, moderate, and severe RHF were 20%, 25%, and 43.8%. The combined 1-year mortality rate for all patients with RHF was 28.3%, which contrasted the 1-year mortality rate for patients without RHF of only 6.7%. Five-year mortality rates (FIGURE 2) for INTERMACS mild, moderate, and severe RHF were 40%, 42.7% and 43.8%. The combined 5-year mortality rate for all patients with RHF was 41.2%, which contrasted the 5-year mortality rate for patients without RHF of 19.7%. For those with RHF who received temporary right VAD (tRVAD) support post-operatively, the average INTERMACS RHF severity was moderate. Ninety-day mortality rates for those with early tRVAD (≤24 hours) and delayed tRVAD (>24 hours) were 25% and 75%. Of those who received tRVAD, the 1-year mortality rate was 25% for those with early tRVAD, while those with delayed tRVAD had a 1-year mortality of 100% and all died on index admission. The 5-year mortality rate for those with RHF and early tRVAD was 50%. Total 90-day mortality for all patients (with and without RHF) was 16.2%. Total 1-year mortality for all patients was 11.7%. Conclusions In our study, 44.1% of patients had RHF after LVAD implantation with nearly 1/3 dying within 1 year. Implantation of early tRVAD seemingly improved 1 year survival as compared to INTERMACS severe RHF.