Abstract 18697: Should Aggressive Implantation of a Temporary Rvad Be Utilized as Means of Recovery for Rv Function to Allow for Long-Term Left Ventricular Assist Device Therapy
Continuous flow left ventricular assist device (LVAD) is an ideal treatment for end-stage heart failure, but right ventricular dysfunction has classically been a contraindication for long term LVAD therapy. For such patients, the primary treatment is medical management with poor survival of 25% at 1 year and 8% at 2 years, at best. Temporary RVAD therapy has thus been applied as a bridge for RV dysfunction to recovery and long term univentricular support. We evaluated the INTERMACS database for those LVAD patients supported with an RVAD to guide therapy for marginal RV function.
Patients undergoing an isolated LVAD implant were identified from 2006-2015 (n= 13,905, LVAD). Recipients of LVADs requiring RVADs, implanted within 24 hours (n=113, LVAD+RVAD early) and 25-72 hours (n=62, LVAD+RVAD late) were identified. Statistical analyses included descriptive statistics and Kaplan-Meier survival analyses.
Preoperatively, a greater number of patients in the LVAD+RVAD cohorts were INTERMACS class I or II compared to LVAD (p=0.0001). Survival at 1 year was reduced in the early and late LVAD+RVAD (42% vs 50% vs 81%) and at 2 years (38% vs 35% vs 70%, log rank= 0.006), compared to isolated LVAD patients but superior to traditional medical outcomes. The top two causes of death were the same amongst the cohorts: multisystem organ failure (27% vs 30% vs 15%) and neurological dysfunction (16% vs 10% vs 19%) but statistically differed (p = 0.02).
Aggressive and early placement of an RVAD following LVAD implant can successfully be used as bridge to long-term LVAD therapy, with survival exceeding medically managed patients. While the incidence of directly identified right heart failure is low, the incidence of multisystem organ failure, often related to right heart failure, remains high in the LVAD+RVAD cohorts. LVAD as long-term therapy may be a viable treatment option amongst patients with marginal RV function, with this analysis serving as an initial guide for patient selection.
Author Disclosures: A.C. Gaffey: None. C.W. Chen: None. J. Han: None. J.E. Rame: None. M.S. Kiernan: None. J. Chung: None. S.L. Myers: None. F.A. Arabia: None. R.K. Kormos: None. M.S. Slaughter: Consultant/Advisory Board; Modest; EvaHeart, Oregon Heart. Research Grant; Significant; Heartware to Institution, Carmat to Institution. D.C. Naftel: None. A.J. Cucchiara: None. M.A. Acker: Consultant/Advisory Board; Modest; Thoratec. P. Atluri: Other; Modest; ENDURANCE Trail PI.
- © 2016 by American Heart Association, Inc.