Impact of Right Heart Failure on Clinical Outcome of Left Ventricular Assist Devices (LVAD) Implantation: Single Center Experience

Abstract

The aim of this study was to examine the incidence and significance of right heart failure (RHF) in the early and late phase of left ventricular assist device (LVAD) implantation with the identification of predictive factors for the development of RHF. This was a prospective observational analytical cohort study. The study included 92 patients who underwent LVAD implantation and for whom all necessary clinical data from the follow-up period were available, as well as unambiguous conclusions by the heart team regarding pathologies, adverse events, and complications. Of the total number of patients, 43.5% died. The median overall survival of patients after LVAD implantation was 22 months. In the entire study population, survival rates were 88.04% at one month, 80.43% at six months, 70.65% at one year, and 61.96% at two years. Preoperative RHF was present in 24 patients, 12 of whom died and 12 survived LVAD implantation. Only two survivors developed early RHF (ERHF) and two late RHF (LRHF). The most significant predictors of ERHF development are brain natriuretic peptide (BNP), pre-surgery RHF, FAC < 20%, prior renal insufficiency, and total duration of ICU stay (HR: 1.002, 0.901, 0.858, 23.554, and 1.005, respectively). RHF following LVAD implantation is an unwanted complication with a negative impact on treatment outcome. The increased risk of fatal outcome in patients with ERHF and LRHF after LVAD implantation results in a need to identify patients at risk of RHF, in order to administer the available preventive and therapeutic methods.

When Nothing Goes Right: Risk Factors and Biomarkers of Right Heart Failure after Left Ventricular Assist Device Implantation

“…Thirty days after LVAD implantation, patients who later developed RHF had significantly reduced serum levels of hemoglobin and platelets, and elevated CRP compared to patients without RHF, possibly implicating a higher incidence of bleeding events in these patients, which is in line with the findings of Rame et al [ 21 ], who reported an increased likelihood of gastrointestinal bleeding in patients with late RHF. Terzic et al [ 27 ] recently found that proBNP and LDH levels may be useful prognostic indicators for the development of early RHF, which was not demonstrated for late RHF in our study.…”

Use of machine learning techniques to identify risk factors for RV failure in LVAD patients

“…The effect of RV failure on LVAD outcomes includes increased mortality, deteriorating renal function and longer length of stay in the ICU, all of which contribute to increased morbidity in addition to its effects on mortality ( 21 ).…”