TY - JOUR
T1 - A multi-institutional retrospective analysis on impact of RV acute mechanical support timing after LVAD implantation on 1-year mortality and predictors of RV acute mechanical support weaning
AU - Kumar, Salil
AU - Derbala, Mohamed H.
AU - Nguyen, Duc T.
AU - Ferrall, Joel
AU - Cefalu, Matthew
AU - Rivas-Lasarte, Mercedes
AU - Rashid, Syed Muhammad Ibrahim
AU - Joseph, Denny T.
AU - Graviss, Edward A.
AU - Goldstein, Daniel
AU - Jorde, Ulrich P.
AU - Bhimaraj, Arvind
AU - Suarez, Erik E.
AU - Smith, Sakima A.
AU - Sims, Daniel B.
AU - Guha, Ashrith
N1 - Funding Information:
M R-L received a mobility Dra. Magda Heras grant from Sociedad Española de Cardiología. SS received funding from NIH-R01MD011307 and NIH-K08HL135437.
Funding Information:
M R-L received a mobility Dra. Magda Heras grant from Sociedad Española de Cardiología . SS received funding from NIH - R01MD011307 and NIH - K08HL135437 .
Publisher Copyright:
© 2021 International Society for Heart and Lung Transplantation
PY - 2022/2
Y1 - 2022/2
N2 - BACKGROUND: There is little insight into which patients can be weaned off right ventricular (RV) acute mechanical circulatory support (AMCS) after left ventricular assist device (LVAD) implantation. We hypothesize that concomitant RV AMCS insertion instead of postoperative implantation will improve 1-year survival and increase the likelihood of RV AMCS weaning.METHODS: A multicenter retrospective database of 826 consecutive patients who received a HeartMate II or HVAD between January 2007 and December 2016 was analyzed. We identified 91 patients who had early RV AMCS on index admission. Cox proportional-hazards model was constructed to identify predictors of 1-year mortality post-RV AMCS implantation and competing risk modeling identified RV AMCS weaning predictors.RESULTS: There were 91 of 826 patients (11%) who required RV AMCS after CF-LVAD implantation with 51 (56%) receiving a concomitant RV AMCS and 40 (44%) implanted with a postoperative RV AMCS during their ICU stay; 48 (53%) patients were weaned from RV AMCS support. Concomitant RV AMCS with CF-LVAD insertion was associated with lower mortality (HR 0.45 [95% CI 0.26-0.80], p = 0.01) in multivariable model (which included age, BMI, angiotensin-converting enzyme inhibitor use, and heart transplantation as a time-varying covariate). In the multivariate competing risk analysis, a TPG < 12 (SHR 2.19 [95% CI 1.02-4.70], p = 0.04) and concomitant RV AMCS insertion (SHR 3.35 [95% CI 1.73-6.48], p < 0.001) were associated with a successful wean.CONCLUSIONS: In patients with RVF after LVAD implantation, concomitant RV AMCS insertion at the time of LVAD was associated with improved 1-year survival and increased chances of RV support weaning compared to postoperative insertion.
AB - BACKGROUND: There is little insight into which patients can be weaned off right ventricular (RV) acute mechanical circulatory support (AMCS) after left ventricular assist device (LVAD) implantation. We hypothesize that concomitant RV AMCS insertion instead of postoperative implantation will improve 1-year survival and increase the likelihood of RV AMCS weaning.METHODS: A multicenter retrospective database of 826 consecutive patients who received a HeartMate II or HVAD between January 2007 and December 2016 was analyzed. We identified 91 patients who had early RV AMCS on index admission. Cox proportional-hazards model was constructed to identify predictors of 1-year mortality post-RV AMCS implantation and competing risk modeling identified RV AMCS weaning predictors.RESULTS: There were 91 of 826 patients (11%) who required RV AMCS after CF-LVAD implantation with 51 (56%) receiving a concomitant RV AMCS and 40 (44%) implanted with a postoperative RV AMCS during their ICU stay; 48 (53%) patients were weaned from RV AMCS support. Concomitant RV AMCS with CF-LVAD insertion was associated with lower mortality (HR 0.45 [95% CI 0.26-0.80], p = 0.01) in multivariable model (which included age, BMI, angiotensin-converting enzyme inhibitor use, and heart transplantation as a time-varying covariate). In the multivariate competing risk analysis, a TPG < 12 (SHR 2.19 [95% CI 1.02-4.70], p = 0.04) and concomitant RV AMCS insertion (SHR 3.35 [95% CI 1.73-6.48], p < 0.001) were associated with a successful wean.CONCLUSIONS: In patients with RVF after LVAD implantation, concomitant RV AMCS insertion at the time of LVAD was associated with improved 1-year survival and increased chances of RV support weaning compared to postoperative insertion.
KW - left ventricular assist device
KW - mechanical circulatory support
KW - mechanical circulatory support complications
KW - right ventricular assist device
KW - right ventricular failure
KW - shock
KW - Follow-Up Studies
KW - Global Health
KW - Weaning
KW - Heart Ventricles/physiopathology
KW - Humans
KW - Middle Aged
KW - Male
KW - Treatment Outcome
KW - Heart Failure/mortality
KW - Survival Rate/trends
KW - Female
KW - Retrospective Studies
KW - Heart-Assist Devices
KW - Heart Transplantation/methods
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U2 - 10.1016/j.healun.2021.10.005
DO - 10.1016/j.healun.2021.10.005
M3 - Article
C2 - 34802875
AN - SCOPUS:85119511083
SN - 1053-2498
VL - 41
SP - 244
EP - 254
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 2
ER -