Incidence and clinical significance of late right heart failure during continuous-flow left ventricular assist device support.
BACKGROUND
Right heart failure (RHF) is an unresolved issue during continuous-flow left ventricular assist device (LVAD) support. Little is known about the incidence and clinical significance of late RHF during LVAD support.


METHODS
Between May 2004 and December 2013, 336 patients underwent continuous-flow LVAD implantation. Of these, 293 patients (87%) discharged with isolated LVAD support were included in this study. Late RHF was defined as HF requiring re-admission and medical or surgical intervention after initial surgery.


RESULTS
Late RHF occurred in 33 patients (11%) at a median of 99 days after discharge (range 19 to 1,357 days). Freedom from late RHF rates were 87%, 84% and 79% at 1, 2 and 3 years, respectively. RHF recurred in 15 patients. Three patients required right ventricular assist device insertion. Univariable Cox proportional hazards regression model showed diabetes mellitus (HR 2.05, 95% CI 1.03 to 4.06, p = 0.04), body mass index >29 (HR 2.47, 95% CI 1.24 to 4.94, p = 0.01) and blood urea nitrogen level >41 mg/dl (HR 2.19; 95% CI 1.10 to 4.36; p = 0.025) as significant predictors for late RHF. Estimated on-device survival rates at 2 years were 73% in the RHF group and 82% in the non-RHF group (p = 0.20). However, overall survival at 2 years was significantly worse in patients who developed late RHF (60% vs 85%, p = 0.016). This reduction was mostly attributed to worse overall outcomes in the bridge-to-transplant (BTT) population.


CONCLUSIONS
Late RHF is common after continuous-flow LVAD implantation, but does not affect survival during LVAD support. However, it is associated with worse overall outcomes in the BTT population.
Department of Surgery, Division of Cardiothoracic Surgery Columbia University Medical Center, New York, New York. Electronic address: kt2485@cumc.columbia.edu.
Koji
K
Takeda
Department of Surgery, Division of Cardiothoracic Surgery Columbia University Medical Center, New York, New York.
Hiroo
H
Takayama
Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
Paolo C
PC
Colombo
Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
Melana
M
Yuzefpolskaya
Department of Surgery, Division of Cardiothoracic Surgery Columbia University Medical Center, New York, New York.
Shinichi
S
Fukuhara
Department of Surgery, Division of Cardiothoracic Surgery Columbia University Medical Center, New York, New York.
Jiho
J
Han
Department of Surgery, Division of Cardiothoracic Surgery Columbia University Medical Center, New York, New York.
Paul
P
Kurlansky
Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
Donna M
DM
Mancini
Department of Surgery, Division of Cardiothoracic Surgery Columbia University Medical Center, New York, New York.
Yoshifumi
Y
Naka
D000328:Adult; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors; D018497:Ventricular Dysfunction, Right / Q000453:epidemiology*
Bridge to transplant; Destination therapy; continuous flow; right heart failure; transplantation; ventricular assist device