Incidence and risk factors of late right heart failure in chronic mechanical circulatory support

Abstract

Background Late right heart failure (LRHF) is a common complication during long‐term left ventricular assist device (LVAD) support. We aimed to identify risk factors for LRHF after LVAD implantation. Methods Patients undergoing primary LVAD implantation between 2006 and 2019 and surviving the perioperative period were included for this study (n = 261). Univariate Cox proportional hazards analysis was used to assess the association of clinical covariates and LRHF, stratified for device type. Variables with p < 0.10 entered the multivariable model. In a subset of patients with complete echocardiography or right catheterization data, this multivariable model was extended. Postoperative cardiopulmonary exercise test data were compared in patients with and without LRHF. Results Nineteen percentage of patients suffered from LRHF after a median of 12 months, of which 67% required hospitalization. A history of atrial fibrillation (AF) (HR: 2.06 [1.08–3.93], p = 0.029), a higher preoperative body mass index (BMI) (HR: 1.07 [1.01–1.13], p = 0.023), and intensive care unit (ICU) duration (HR: 1.03 [1.00–1.06], p = 0.025) were independent predictors of LHRF in the multivariable model. A significant relation between the severity of tricuspid regurgitation (TR) and LRHF (HR: 1.91 [1.13–3.21], p = 0.016) was found in patients with echocardiographic data. Patients with LRHF demonstrated a lower maximal workload and peak VO2 at 6 months postoperatively. Conclusion A history of AF, BMI, and longer ICU stay may help identify patients at high risk for LRHF. Severity of TR was significantly related to LRHF in a subset of patients

Concomitant tricuspid valve surgery in patients undergoing left ventricular assist device: a systematic review and meta-analysis

“…One may argue that TVS is theoretically instrumental in decreasing RV volume, promoting RV reverse remodeling, and thus, improving overall RV performance 43 , 44 . Another argument is that TR severity was strongly associated with postimplant RHF, so a forward intervention during the implantation would make a difference 6 , 45 , 46 .…”

“…Previous studies have shown that tricuspid regurgitation (TR) occurred before or after the operation in a percentage of patients who received LVAD implantation 3 – 5 . As moderate to greater TR was confirmed to be associated with poorer perioperative performance and declined survival in patients undergoing LVAD, the necessity of concomitant tricuspid valve surgery (TVS) during LVAD implantation has been noticed and evaluated over time 4 , 6 , 7 . Initially, TVS was identified as instrumental in promoting reverse remodeling of the right ventricle (RV), reducing the incidence of right heart failure (RHF), and improving clinical outcomes 3 , 8 , 9 .…”

Catheter Ablation for Tachyarrhythmias in Left Ventricular Assist Device Recipients: Clinical Significance and Technical Tips

“…However, LVAD therapy originally requires warfarin administration to prevent pump thrombosis and ultimately reduce the load on the left ventricle, irrespective of the presence of AF, potentially mitigating the negative impact of AF. Nevertheless, several observational studies have reported that preoperative AF, particularly the persistent type, is associated with increased mortality, a higher degree of functional tricuspid regurgitation, a higher incidence of new-onset ventricular arrhythmias, and a greater occurrence of late right heart failure when compared to individuals without AF [3,[14][15][16].…”

“…The LVAD effectively provided support for 60 min during VF with sinus rhythm; however, it was noted that AF was unable to sustain both systemic and pulmonary circulation in the presence of elevated central venous pressure [21]. This result may, in part, be influenced by right ventricular failure associated with AF; nonetheless, it underscores the significance of maintaining sinus atrial rhythm in such a specific scenario [16,22]. Further studies are warranted to better clarify the clinical implication of the presence of AF during durable LVAD supports.…”

Timelines of adverse event journeys of LVAD patients

“…The temporal aspect of this Events data provides a natural ordering of events with an inherent semantic structure. Previous studies based on the Events dataset over the past decades focused on individual AEs (for example right heart failure, 2 bleeding, 3 infection 4 etc.) Investigators have yet to focus on the timeline of the AE journey of LVAD patients, for example to investigate the duration of the AE journey (time between the first and last AE) or the most common time at which the first or last AE occurs.…”