Early Right Ventricular Assist Device Use in Patients Undergoing Continuous-Flow Left Ventricular Assist Device Implantation: Incidence and Risk Factors from the Interagency Registry for Mechanically Assisted Circulatory Support

Michael S. Kiernan, E. Wilson Grandin, Marshall Brinkley, Navin K. Kapur, Duc Thinh Pham, Robin Ruthazer, J. Eduardo Rame, Pavan Atluri, Edo Y. Birati, Guilherme H. Oliveira, Francis D. Pagani, James K. Kirklin, David Naftel, Robert L. Kormos, Jeffrey J. Teuteberg, David Denofrio

Research output: Contribution to journalArticlepeer-review

85 Scopus citations

Abstract

Background: To investigate preimplant risk factors associated with early right ventricular assist device (RVAD) use in patients undergoing continuous-flow left ventricular assist device (LVAD) surgery. Methods and Results: Patients in the Interagency Registry for Mechanically Assisted Circulatory Support who underwent primary continuous-flow-LVAD surgery were examined for concurrent or subsequent RVAD implantation within 14 days of LVAD. Risk factors for RVAD implantation and the combined end point of RVAD or death within 14 days of LVAD were assessed with stepwise logistic regression. We compared survival between patients with and without RVAD using Kaplan-Meier method and Cox proportional hazards modeling. Of 9976 patients undergoing continuous-flow-LVAD implantation, 386 patients (3.9%) required an RVAD within 14 days of LVAD surgery. Preimplant characteristics associated with RVAD use included interagency registry for mechanically assisted circulatory support patient profiles 1 and 2, the need for preoperative extracorporeal membrane oxygenation or renal replacement therapy, severe preimplant tricuspid regurgitation, history of cardiac surgery, and concomitant procedures other than tricuspid valve repair at the time of LVAD. Hemodynamic determinants included elevated right atrial pressure, reduced pulmonary artery pulse pressure, and reduced stroke volume. The final model demonstrated good performance for both RVAD implant (area under the curve, 0.78) and the combined end point of RVAD or death within 14 days (area under the curve, 0.73). Compared with patients receiving an isolated LVAD, patients requiring RVAD had decreased 1-and 6-month survival: 78.1% versus 95.8% and 63.6% versus 87.9%, respectively (P<0.0001 for both). Conclusions: The need for RVAD implantation after LVAD is associated with indices of global illness severity, markers of end-organ dysfunction, and profiles of hemodynamic instability.

Original languageEnglish
Article numbere003863
JournalCirculation: Heart Failure
Volume10
Issue number10
DOIs
StatePublished - 1 Oct 2017
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2017 American Heart Association, Inc.

Funding

This project was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, award number UL1TR001064. Data collection for this work was funded in whole or in part with Federal Funds from the National Heart, Lung and Blood Institute, National Institutes of Health, Department of Heath and Human Services, under Contract No. HHSN268201100025C. The content was generated through an INTERMACS collaboration. We would like to thank the INTERMACS investigators, coordinators, and participating institutions for the data they have provided for this registry. Dr Birati has received fellowship and research support from Medtronic. Dr Kiernan has received consulting and speaking honoraria from Medtronic and sponsored travel from Abbott.

FundersFunder number
Department of Heath and Human Services
National Institutes of Health
National Heart, Lung, and Blood Institute
Medtronic
National Center for Advancing Translational SciencesUL1TR001064

    Keywords

    • atrial pressure
    • blood pressure
    • heart
    • humans
    • risk factors

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