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Circ Heart Fail. 2017 Oct;10(10). pii: e003863. doi: 10.1161/CIRCHEARTFAILURE.117.003863.

Early Right Ventricular Assist Device Use in Patients Undergoing Continuous-Flow Left Ventricular Assist Device Implantation: Incidence and Risk Factors From the Interagency Registry for Mechanically Assisted Circulatory Support.

Author information

1
From the Cardiovascular Center, Tufts Medical Center, Boston, MA (M.S.K., N.K.K., D.D.); Cardiovascular Institute, Beth Israel Deaconess Medical Center, Boston, MA (E.W.G.); Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN (M.B.); Division of Cardiothoracic Surgery, Northwestern Memorial Hospital, Chicago, IL (D.T.P.); Clinical and Translational Science Institute, Tufts University, Boston, MA (R.R.); Heart and Vascular Institute, University of Pennsylvania, Philadelphia (J.E.R., E.Y.B.); Division of Cardiology, University Hospitals, Cleveland, OH (P.A., G.H.O.); Division of Cardiothoracic Surgery, University of Michigan School of Medicine, Ann Arbor (F.D.P.); Division of Cardiothoracic Surgery, University of Alabama Birmingham School of Medicine (J.K.K.); University of Alabama Birmingham School of Public Health (D.N.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (R.L.K., J.J.T.). mkiernan@tuftsmedicalcenter.org.
2
From the Cardiovascular Center, Tufts Medical Center, Boston, MA (M.S.K., N.K.K., D.D.); Cardiovascular Institute, Beth Israel Deaconess Medical Center, Boston, MA (E.W.G.); Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN (M.B.); Division of Cardiothoracic Surgery, Northwestern Memorial Hospital, Chicago, IL (D.T.P.); Clinical and Translational Science Institute, Tufts University, Boston, MA (R.R.); Heart and Vascular Institute, University of Pennsylvania, Philadelphia (J.E.R., E.Y.B.); Division of Cardiology, University Hospitals, Cleveland, OH (P.A., G.H.O.); Division of Cardiothoracic Surgery, University of Michigan School of Medicine, Ann Arbor (F.D.P.); Division of Cardiothoracic Surgery, University of Alabama Birmingham School of Medicine (J.K.K.); University of Alabama Birmingham School of Public Health (D.N.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (R.L.K., J.J.T.).

Abstract

BACKGROUND:

To investigate preimplant risk factors associated with early right ventricular assist device (RVAD) use in patients undergoing continuous-flow left ventricular assist device (LVAD) surgery.

METHODS AND RESULTS:

Patients in the Interagency Registry for Mechanically Assisted Circulatory Support who underwent primary continuous-flow-LVAD surgery were examined for concurrent or subsequent RVAD implantation within 14 days of LVAD. Risk factors for RVAD implantation and the combined end point of RVAD or death within 14 days of LVAD were assessed with stepwise logistic regression. We compared survival between patients with and without RVAD using Kaplan-Meier method and Cox proportional hazards modeling. Of 9976 patients undergoing continuous-flow-LVAD implantation, 386 patients (3.9%) required an RVAD within 14 days of LVAD surgery. Preimplant characteristics associated with RVAD use included interagency registry for mechanically assisted circulatory support patient profiles 1 and 2, the need for preoperative extracorporeal membrane oxygenation or renal replacement therapy, severe preimplant tricuspid regurgitation, history of cardiac surgery, and concomitant procedures other than tricuspid valve repair at the time of LVAD. Hemodynamic determinants included elevated right atrial pressure, reduced pulmonary artery pulse pressure, and reduced stroke volume. The final model demonstrated good performance for both RVAD implant (area under the curve, 0.78) and the combined end point of RVAD or death within 14 days (area under the curve, 0.73). Compared with patients receiving an isolated LVAD, patients requiring RVAD had decreased 1- and 6-month survival: 78.1% versus 95.8% and 63.6% versus 87.9%, respectively (P<0.0001 for both).

CONCLUSIONS:

The need for RVAD implantation after LVAD is associated with indices of global illness severity, markers of end-organ dysfunction, and profiles of hemodynamic instability.

KEYWORDS:

atrial pressure; blood pressure; heart; humans; risk factors

[Indexed for MEDLINE]
Free PMC Article

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