Incidence and Outcomes of Late-Onset Right Ventricular Failure in Patients with Left Ventricular Assist Device

Right Ventricular Failure (RVF) is an incompletely understood complication observed in patients undergoing durable left ventricular assist device (LVAD) implantation. Prior research has primarily concentrated on early post-implantation RVF. This study seeks to characterize the incidence and clinical features associated with late-onset RVF in LVAD patients. Methods: This retrospective cohort study included individuals undergoing LVAD implantation at the University of Washington (2005-2021), with at least 30 days of support. Late-onset RVF was defined based on Mechanical Circulatory Support Academic Research Consortium criteria, occurring over 30 days post-implantation. The outcomes of interest were time to late-onset RVF and mortality on LVAD support. Potential causal factors were examined using cause-specific models accounting for the competing events, transplant, or cardiac recovery requiring LVAD explantation. Cox regression models assessed the risk of death associated with late-onset RVF as a time-varying exposure after LVAD implantation. Results: The cohort comprised 497 LVAD recipients, with a median age of 56 years (interquartile range 45-64), 18% women, and 75% Caucasian. Late-onset RVF criteria were met by 120 subjects, resulting in an incidence rate of 15.6 events per 1,000 person-months. Cause-specific competing risk analysis, stratified by self-identified ancestor identity, revealed associations between higher body mass index (BMI), peripheral vascular disease, INTERMACS 1 or 2, and longer cardiopulmonary bypass time with late-onset RVF development. Conversely, ischemic cardiomyopathy and the use of temporary MCS before LVAD implantation were linked to a reduced likelihood of late-onset RVF. After adjustment, late-onset RVF was associated with an increased hazard of death (HR: 2.8, 95% CI: 2.0–4.0 p<0.001). Conclusion: Within this cohort, late-onset RVF was a prevalent complication linked to elevated mortality. Peripheral vascular disease proved to be the most robust predictor for late-onset RVF, while prior mechanical circulatory support before LVAD emerged as a protective factor against this complication. Future investigations should extend to different cohorts to better understand the impact of this complication.