Right HF after LVAD implantation raises risk for hospitalization, major adverse events
For patients on left ventricular assist device support, the development of right HF at 3 months postimplantation increased the risk for repeated hospitalization and major adverse events, researchers reported.
According to J. Eduardo Rame, MD, MPhil, enterprise chief of advanced cardiac and pulmonary vascular disease programs and Louis R. Dinon professor of clinical cardiology at Thomas Jefferson University Hospitals in Philadelphia, and colleagues, the consensus definition of right HF (RHF) from the Society of Thoracic Surgeons Intermacs database, adopted in 2014, has allowed the field to determine the presence and severity of RHF longitudinally as opposed to just in the early postoperative phase of support.
“We sought to assess how the incidence of RHF changes over time after LVAD implantation and to determine the impact of late RHF on survival, subsequent hospitalization and clinically important adverse events,” they wrote.
For the study, Rame and colleagues included patients in the Intermacs database with follow-up. All patients received support for at least 3 months with a continuous-flow LVAD that had been implanted from June 2, 2014, to March 31, 2017. Additionally, patients were not simultaneously receiving support from a right ventricular assist device.
Both documentation and manifestations of elevated central venous pressures served as the definition for RHF.
Overall, the study featured 6,118 patients with an incidence of RHF at 3, 6 and 12 months after implantation.
At 3 months postimplantation, 5% of patients were categorized as having mild RHF and 5% as moderate RHF, whereas at both 6 and 12 months, 6% of patients had mild RHF and 3% had moderate RHF.
For patients with no RHF at 3 months, the incidence of subsequent RHF at 6 and 12 months was low.
In other data, compared with patients who had mild or moderate RHF at 3 months, those who had no RHF demonstrated a lower 12-month cumulative incidence of mortality (none, 6.9%; mild, 16.7%; moderate, 28.1%; P < .0001). Additionally, the lack of RHF at 3 months was associated with a lower 12-month cumulative incidence of stroke (none, 7.4%; mild, 9.5%; moderate, 11%; P = .0095), gastrointestinal bleeding (none, 14.8%; mild, 24.2%; moderate, 23.6%; P < .0001) and rehospitalization (none, 65.2%; mild, 73.2%; moderate, 71.2%; P < .0001).
“Patients on left ventricular mechanical circulatory support who later develop RHF are at increased risk for repeated hospitalization and major adverse events, including mortality,” the researchers wrote. “Studies of the right ventricular response to chronic mechanical support are needed to determine the factors leading to development of late RHF and develop effective mitigation strategies.”
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