Timing Of RVAD Insertion and The Associated Outcomes in CF-LVAD Patients

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Study Right ventricular assist devices (RVAD) are commonly used for severe right heart failure (RHF) after continuous flow left ventricular assist device (CF-LVAD) insertion. However, the timing of RVAD insertion and the associated outcomes in CF-LVAD patients remains unclear. This study evaluates the effect of timing of RVAD insertion on long-term outcomes of CF-LVAD patients. Methods We performed a retrospective review CF-LVAD implantations from Jan 2001 through Mar 2017 at our center. From this, we culled out patients who received an RVAD and divided this cohort into early insertion (≤24 hours after CF-LVAD placement) and delayed insertion (>24 hours and ≤30days after CF-LVAD placement) groups. We compared early and late outcomes in the two groups. Results Within the CF-LVAD placement cohort (n=692), 61 (8.82%) patients required RVAD for severe RHF, with 35 (57.4%) patients in the early insertion group and 26 (42.6%) in the delayed insertion group. The majority of patients received temporary-type RVADs (CentriMag=42, TandemHeart=3) while some received durable-type RVADs (HeartWare=5, HeartMateII=1, Abiomed5000=4, Jarvik2000=1, Thoratec PVAD=3, Biomedicus=1). The mean duration of RVAD support was 48.8 days. In the early group, 17 (48.6%) patients were successfully weaned vs. 10 (38.5%) in the delayed group (p=NS). Overall differences between the early and late group have been summarized in Table 1 . Thirty-day mortality was similar for early 19 (54.3%) vs. delayed group 15 (57.7%) (p=NS) (Figure 1). There was no significant difference between the two groups in successfully bridging to transplantation. The 12-month overall survival rate in early placement patients was 16.7% and 26.9% in the delayed placement patients (p=NS) (Figure 1). Conclusions In this cohort of patients, no significant differences were found between the early and delayed groups in length of stay or 30-day readmission rates. There is no effect of timing of RVAD insertion on long-term outcomes of CF-LVAD patients. Prospective randomized trials can be designed to answer this equipoise effectively.