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

Claudio Bravo Carillo | 2023

Advisor: Nicholas L. Smith

Research Area(s): Cardiovascular & Metabolic Disease

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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.