Totally Percutaneous RVAD/ECMO Configuration Provides Versatile Support for RV Failure

Abstract

and pre-implant MR ≥ moderate. RHF was defined as the need for unplanned right ventricular assist device (RVAD) or post-LVAD inotropic support for either ≥ 14 days (RHF-14d) or, more conservatively, ≥ 21 days (RHF-21d), consistent with our previously reported outcomes. Results: Fourteen patients (7%) required RVAD, 24 (12%) required inotropes for ≥ 21 days and 35 (18%) for 14-20 days. After adjustment for pulmonary artery wedge pressure, pulmonary vascular resistance, and heart rate, MR severity was inversely related to PACi (p = 0.015) and was a determinant of PACi in linear regression modeling (p = 0.037). There was a significant association between PACi/MR category and the incidence of RHF (Figure), and 57% of patients requiring RVAD were in the Low PACi/Less MR group. In multivariate logistic regression, PACi and MR were strongly associated with RHF-21d (Figure), and there was a significant interaction between these variables (p-interaction < 0.05). Conclusion: Greater MR severity is associated with increased RV pulsatile load but reduced rates of early RHF after cfLVAD. These findings suggest that MR represents a unique, LVAD-responsive RV load, and this paradigm may help risk stratify patients for post-LVAD RHF.