2015•The Thoracic and Cardiovascular SurgeonRequires access
Predictors of Requirement for Right Ventricular Assist Device Implantation Following Continuous-Flow Left Ventricular Assist Device Implantation as a Bridge to Transplantation
Nikhil P. Patil, Anton Sabashnikov, Alexander Weymann, Prashant N. Mohite, Dhruva Dhar, D. García, B. Zych, Christopher T. Bowles, Rachel Hards, Ankush Moza, F. De Robertis, Toufan Bahrami, M. Amrani, Shelley Rahman-Haley, N.R. Banner, Aron‐Frederik Popov, André Simon
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Abstract
Objectives: Outcomes of ventricular assist device (VAD) therapy remain limited by right ventricular failure (RVF). We sought to define predictors of RVF requiring right VAD (RVAD) support following continuous-flow left VAD (cfLVAD) implantation and evaluate its impact on longer-term outcomes. Methods: Perioperative clinical, echocardiographic, hemodynamic and laboratory data of cfLVAD recipients for last ten years were analyzed, comparing patients who developed severe RVF requiring right VAD (RVAD) to the rest of the patient cohort. 01/04/2014 was chosen as cut-off date for observations. Multivariate logistic regression analysis was performed on univariate predictors for severe RVF with an entry criterion of p < 0.05. Results: Between July 2003 and June 2013, 164 cfLVADs were implanted as bridge to transplantation in 151 patients: 73 (44.5%) HeartMate II (Thoratec Corp, Pleasanton, CA), 68 (41.5%) HeartWare (Heart International, Inc., Framingham, MA) and 23 (14.0%) Jarvik 2000 (Jarvik Heart, Inc., New York, NY). The overall postoperative incidence of severe RVF requiring RVAD support was 23.2% ( n = 38). RVAD implantation did not significantly affect eventual transplantation ( p = 0.336) or longer-term survival ( p = 0.318). Multivariate analysis revealed female gender ( p = 0.013, 95% CI 2.034–433.671, OR 29.698), lesser tricuspid annular plane systolic excursion (TAPSE) ( p = 0.08, 95% CI 0.387–0.865, OR 0.579) and smaller left atrial diameter ( p = 0.027, 95% CI 0.739–0.982, OR 0.852) as independent predictors of RVAD implantation postoperatively. Preoperative right ventricular diameter (RVD), pulmonary regurgitation (PR) and alanine transaminase (ALT) levels were univariate predictors ( p < 0.001, p = 0.012 and p = 0.048 respectively), while RVD and PR trended toward (but did not meet criteria for) significance ( p = 0.060 and p = 0.063, respectively) as independent predictors for RVAD implantation in multivariate analysis. Conclusions: Female gender, lesser TAPSE and smaller left atrial diameter are independent predictors of severe RVF requiring mechanical support following cfLVAD implantation. RVAD implantation does not adversely affect eventual transplantation or survival following cfLVAD implantation.