Abstract 14454: Inhaled Epoprostenol is Equivalent to Inhaled Nitric Oxide for Right Ventricular Failure Following Left Ventricular Assist Device Placement
Introduction: Right ventricular failure following left ventricular assist device placement increases morbidity and mortality. Inhaled pulmonary vasodilators are frequently used to prevent and treat RV failure. Scant evidence exists comparing inhaled nitric oxide (iNO) and inhaled epoprostenol in this setting.
Hypothesis: Inhaled epoprostenol and iNO have similar efficacy and risk following durable LVAD placement for end stage cardiac failure.
Methods: The Stanford Translational Research Integrated Database Environment was queried for patients >18 years old carrying CPT codes 33979 (Insertion of ventricular assist device, implantable intracorporeal, single ventricle) and keywords “Heartware” or “Heartmate”. Each chart was manually reviewed. Patients were excluded for complex congenital disease, post-cardiotomy LV failure, and treatment with both or neither inhaled agents. Univariate analysis and multivariate analysis with an endpoint of early RV failure were performed. In all cases, pulmonary vasodilation was instituted at the start of cardiopulmonary bypass in the operating room.
Results: 155 adults had continuous flow durable LVADs implanted and were treated with either iNO or epoprostenol from 2010-2015. 72 were treated with epoprostenol, and 83 with iNO. INTERMACS class was similar between the groups. More redo sternotomies were performed for epoprostenol patients (n=26, 31.3% vs. n=12, 16.7%, p=0.034), as were Heartware implants (n=47, 65.3% vs. n=25, 34.7%, p<0.001). In univariate analysis, early RV failure occurred more often in the iNO group (n=60, 72.3% vs. n=40, 55.6%, p=0.030). There was no difference in early mortality, ICU or hospital length of stay, duration of inotropic support, renal failure requiring dialysis, or bleeding events between groups. More RBC transfusions occurred in the first 48 hours for the iNO group (6.91±6.1 vs. 4.67±5.85, p=0.034). Multivariate analysis failed to demonstrate that iNO was an independent risk factor for early RV failure (OR=2.11, 95% CI: 0.441-10.063).
Conclusions: Compared with iNO, inhaled epoprostenol is a safe and effective treatment for postoperative RV dysfunction after LVAD placement. Larger cohorts and randomized controlled trials are needed to confirm this finding.
Author Disclosures: S. Zeigler: None. C. Hill: None. Y. Shudo: None. H. Wang: None. Y. Woo: None. D. Banerjee: None. R. Ha: Honoraria; Modest; Heartware Speaking Fees.
- © 2016 by American Heart Association, Inc.