Effectiveness of temporary mechanical support in patients with refractory right heart failure after implantation of left ventricular assist devices

Objectives: While implantation of left Ventricular Assist Devices (LVADs) has become a routine clinical option for patients in end stage heart failure, many patients experience at least a transient decline in right ventricular (RV) function, commencing the initiation of left ventricular support. Of these, a significant percentage develops refractory full RV failure which is associated with a high mortality. We present our institutional experience in this patient group, based on the results using the CentriMag® (Levitronix) for temporary RV support.

Methods: All patients needing RV support after LVAD implantation between March 2001 and November 2010 were included. The analysis included patient demographics, type of LVAD implanted, duration of RV support and outcome parameters, including survival at 30, 90 days and one year. Patients were clustered according to the devices implanted.

Results: 110 patients underwent implantation of long term, total implantable, continuous flow LVADs: 60 HeartMate II, 25 Jarvik 2000 and 24 HeartWare. 24 patients required right ventricular support. In all cases the Levitronix CentriMag continuous flow, paracorporeal device was used. Pts.: age 37.9±13.7 years, gender: M/F –15/9, underlying disease: dilative cardiomyopathy 22(92%), peripartum cardiomyopathy 1(4%), viral myocarditis 1(4%). Median duration of support: 28 days (5–146). 3(12.5%) pts. underwent heart transplantation (HTx) on RV support, 14(58.5%) underwent RVAD explantation. Of these, 3 underwent successful HTx, 4 recovered LV function followed by LVAD explantation, 3 remain on LVAD support. 4 patients died after RVAD explantation (post explantation day 1, months 3 and 4 and at 2 years), 7(29%) patients died during RV support. Median ITU/hospital stay was 19.5/78.5days days (6–145/10–219). 30-day/90-day/1-year survival: 79%/71%/60%. 15 (62.5%) patients were discharged from hospital after treatment. Median survival after procedure: 475 days (10–1920).

Conclusions: Clinically relevant RV failure occurs in a significant number of patients after implantation of left ventricular assist devices. In these patients, temporary right ventricular support using the CentriMag® is an excellent treatment option allowing to bridge the patient to recovery of RV function or transplantation.