Left Ventricular Assist Device Implantation May Be Feasible in Appropriately Selected Patients with Associated Right Ventricular Dysfunction

Objectives: Right ventricular (RV) failure portends poor outcomes after left ventricular assist device (LVAD) implantation. Current guidelines recommend that tricuspid regurgitation should be addressed with annuloplasty valve repair (TVR) to avoid RV failure post-LVAD insertion. The present study aimed to investigate the impact of preoperative RV dysfunction on short-term survival after LVAD implantation.

Methods: A retrospective, single-center analysis of patients undergoing LVAD implantation between September 2015 and February 2019 was performed. The primary outcome was in-hospital survival. Perioperative characteristics including RV function, pulmonary hypertension (PHT) and post-LVAD implantation adverse events were assessed and compared.

Results: Of 24 patients studied, 17 (70.8%) survived hospital stay. Age (62.2 ± 12.3 vs. 66.1 ± 8.5 years), male gender (82.4 vs. 71.4%), preoperative LV-EF (15.9 ± 5.3 vs. 13.6 ± 3.8%), incidence of preoperative ICD (41.2 vs. 71.4%), dialysis (29.4 vs. 14.3%), previous cardiac surgery (28.6 vs.14.2%), preoperative shock (52.9 vs. 42.9%), CPR (35.3 vs. 42.9%), and ECMO (35.3 vs. 28.6%) did not differ in survivors and nonsurvivors, respectively. Concomitant cardiac surgery has been similarly (42.9 vs. 17.6%) performed in both groups. Whereas survivors received more often preoperatively Impella (35.3 vs.0%, p = 0.037), had shorter intubation time (3.3 ± 3.5 vs. 11.4 ± 11.1 days, p = 0.0053) and ICU stay (12.4 ± 9.8 vs. 34.3 ± 34 days, p = 0.01) compared to nonsurvivors respectively, nonsurvivors suffered more of preoperative PHT (85.7 vs. 47.1%, p = 0.043), had higher preoperative mean PAP values (37.0 ± 9.6 vs. 29.8 ± 12.2 mm Hg, p = 0.044 gH) and received more concomitant TVR (42.9 vs. 11.8%, p = 0.047) than survivors respectively. Nonetheless, survivors receiving TVR had lower preoperative mean PAP (26.7 ± 5.8 vs. 45 ± 5 mm Hg, p = 0.007) compared to nonsurvivors receiving TVR.

Conclusion: In this cohort, patients with relevant preoperative PHT have the highest risk of death after LVAD. Concomitant tricuspid valve repair appears to be beneficial only in patients with moderate preoperative PHT. These findings confirm the need for biventricular mechanical support in patients suffering from severe PHT in addition to LV failure.