Background
There is little insight into which patients can be weaned off right ventricular (RV)
acute mechanical circulatory support (AMCS) after left ventricular assist device (LVAD)
implantation. We hypothesize that concomitant RV AMCS insertion instead of postoperative
implantation will improve 1-year survival and increase the likelihood of RV AMCS weaning.
Methods
A multicenter retrospective database of 826 consecutive patients who received a HeartMate
II or HVAD between January 2007 and December 2016 was analyzed. We identified 91 patients
who had early RV AMCS on index admission. Cox proportional-hazards model was constructed
to identify predictors of 1-year mortality post-RV AMCS implantation and competing
risk modeling identified RV AMCS weaning predictors.
Results
There were 91 of 826 patients (11%) who required RV AMCS after CF-LVAD implantation
with 51 (56%) receiving a concomitant RV AMCS and 40 (44%) implanted with a postoperative
RV AMCS during their ICU stay; 48 (53%) patients were weaned from RV AMCS support.
Concomitant RV AMCS with CF-LVAD insertion was associated with lower mortality (HR
0.45 [95% CI 0.26-0.80], p = 0.01) in multivariable model (which included age, BMI, angiotensin-converting enzyme
inhibitor use, and heart transplantation as a time-varying covariate). In the multivariate
competing risk analysis, a TPG < 12 (SHR 2.19 [95% CI 1.02-4.70], p = 0.04) and concomitant RV AMCS insertion (SHR 3.35 [95% CI 1.73-6.48], p < 0.001) were associated with a successful wean.
Conclusions
In patients with RVF after LVAD implantation, concomitant RV AMCS insertion at the
time of LVAD was associated with improved 1-year survival and increased chances of
RV support weaning compared to postoperative insertion.
KEYWORDS
Abbreviations:
CF-LVAD (continuous-flow left ventricular assist device), RV AMCS (right ventricular acute mechanical circulatory support)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 25, 2021
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