Incidence and clinical significance of late right heart failure during continuous-flow left ventricular assist device support

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:34

Article

Takeda, Koji¹  Takayama, Hiroo¹  Colombo, Paolo C.²  Yuzefpolskaya, Melana²  Fukuhara, Shinichi¹  Han, Jiho¹  Kurlansky, Paul¹  Mancini, Donna M.²  Naka, Yoshifumi¹ 

[1] Columbia Univ, Med Ctr, Div Cardiothorac Surg, Dept Surg, New York, NY 10032 USA

[2] Columbia Univ, Med Ctr, Div Cardiol, Dept Med, New York, NY 10032 USA

关键词: continuous flow;    right heart failure;    transplantation;    ventricular assist device;    Bridge to transplant;    Destination therapy;   

DOI  :  10.1016/j.healun.2015.03.011

来源: Elsevier

【 摘 要 】

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 I, 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 (BIT) 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. Published by Elsevier Inc.

【 授权许可】

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