Abstract 16145: Right Ventricular Dysfunction Should Not Preclude Left Ventricular Assist Device Explantation in Patients Exhibiting Left Ventricular Recovery
Background: A subset of patients implanted with ventricular assist devices (VADs) for decompensated heart failure (HF) will develop enough myocardial recovery to allow explantation of their devices. Right ventricular (RV) function is a powerful predictor of outcomes in HF independent of left ventricular function. Some degree of RV dysfunction is common in patients supported by LVADs. Little is known about what happens to the RV following LVAD explantation. Furthermore, it remains unknown whether the presence of RV dysfunction should preclude device explantation. We hypothesized that RV function would remain stable following LVAD explantation.
Methods/Results: A retrospective review was performed of all 70 patients who underwent VAD implantation at our institution from 2002-2011. Of these, 10 patients (14%) recovered myocardial function enough to allow explantation. Of these, the 7 who underwent isolated LVAD implantation were included in this analysis. This was a young cohort (mean age 35) with the majority of patients presenting with new onset HF (71%) and non-ischemic cardiomyopathy (86%). Patients were followed for a mean of 729 days following explantation. All patients had severe LV dysfunction at the time of LVAD implantation (mean LVEF 16%) but achieved significant recovery by the time of explantation (mean LVEF 52%). A significant proportion of patients (43%) had moderate or severe RV dysfunction immediately pre-explantation. No patients had moderate or severe RV dysfunction at one month post-explantation. Quantitative RV function improved from mean fractional area change (FAC) of 36.4% to 39.6% (p=0.41) (Figure).
Conclusion: Patients who have achieved LV recovery after LVAD support can be successfully explanted in spite of RV dysfunction. RV function appears to improve following LVAD explantation making patients traditionally viewed to be ineligible for explantation possible candidates.
- © 2011 by American Heart Association, Inc.