Isolated RVAD implantation - first results from the EUROMACS registry

Objectives: Once, right ventricular dysfunction occurs, it is difficult to treat and associated with high mortality. Temporary short-term devices for right ventricular assistance are available and have been used for temporary right heart support. Recently, isolated RVAD implantation with HVAD devices has been reported. However, isolated implantation on the right side is rare and still an off-label use. For this study data from the EUROMACS database in which procedures and outcomes data for patients receiving mechanical circulatory support are registered, were used.

Methods: Until September 2013 data of 37 patients (mean age 56.0 ± 12.9 years, 64.9% male) with an isolated RVAD were submitted to the EUROMACS registry. Thirty patients received a Levitronix CentriMag, 7 patients an HVAD, and one patient another device. All patients were in INTERMACS class 1,2, or 3. One patient was switched from Levitronix to HVAD. Results of the EUROMACS registry were analysed.

Results: Inflow cannulas were implanted into the RA in 16 patients, the RV in 15 patients and the inflow site was not specified In 7 patients. Mean RVAD flow was 5.0 ± 0.9 l/min at 3452 ± 627 rpm in the Levitronix group and 4.8 ± 1.2 l/min at 2440 ± 476 rpm in the HVAD group. In patients supported by a Levitronix CentriMag, the device was explanted in 36.7%. Mean support time on the Levitronix Centrimag device was 16.3 ± 23.1 days. The 30 day survival was 26.7%. One patient was switched from Levitronix to an HVAD. In patients with an HVAD, 30-day survival was 42.3%. In the surviving 3 patients, 1 patient was transplanted after 419 days, one device was explanted after 40 days due to pump thrombosis and recovered RV function, one patient is still on the device after 494 days.

Conclusion: In this very specific and sick patient cohort, isolated RVAD implantation is associated with acceptable results, especially after HVAD implantation.