S. K. Sundararajan1, M. Cain3, B. Badu3, L. Durham3, L. Joyce3, N. Gaglianello2, D. Ishizawar2, M. Saltzberg2, D. Joyce3, A. Mohammed2 1Medical College Of Wisconsin,General Internal Medicine/Medicine/Medical College Of Wisconsin,Milwaukee, WI, USA 2Medical College Of Wisconsin,Cardiology/Medicine/Medical College Of Wisconsin,Milwaukee, WI, USA 3Medical College Of Wisconsin,Cardiothoracic Surgery/Surgery/Medical College Of Wisconsin,Milwaukee, WI, USA
Introduction:
Right ventricular (RV) failure is a frequent complication of left ventricular assist device (LVAD) implantation in patients with end-stage heart failure, impacting 20% of patients. RV failure post LVAD is associated with 40% 1-year mortality. Percutaneous support can be used in this scenario, however data supporting this approach is lacking.
Methods:
A retrospective review was conducted of all patients who developed severe RV failure requiring use of a right internal jugular placed percutaneous right ventricular assist device (RVAD) following durable LVAD implant at our academic institution between 01/01/2017 and 07/31/2018. Patient demographics were reviewed in addition to key hemodynamic and laboratory values were collected pre-RVAD implantation (immediately prior to cannulation) and at the time of explant (post-RVAD). Pre-RVAD and post-RVAD data was compared using paired T tests. Survival at 30 days or at date of hospital discharge (whichever was longer) was considered as the primary outcome. Patient hemodynamic measures were evaluated as secondary outcomes.
Results:
Of 41 patients who received LVAD, 10 (24%) developed severe RV failure postoperatively. Baseline characteristics include age 51±14.5 years, with 30% females. Incidence of ischemic cardiomyopathy was 20%. Most patients received LVAD as destination therapy (80%). RVAD support via percutaneous cannulation was maintained for a median duration of 15.5 days (Range – 7 to 23 days). Survival at 30 days or to hospital discharge was 100%. RVAD support was successfully weaned in 9 patients (90%), while the remaining 1 patient underwent cardiac transplantation. We observed a reduction in central venous pressure from 17.2±4.5 mm(Hg) to 11±3.1 mm(Hg), p=0.004 and an increase in LVAD flow from 4.5±0.8 l/min to 5.1±0.4 l/min, p=0.018. There was a trend towards increase in mixed venous oxygen saturation from 61.5±11.1% to 67.0±7.0%, p=0.224. Other biochemical parameters collected at the time of percutaneous RVAD support and 24-48 hours after RVAD explant are described in the table below.
Conclusion:
Use of a right internal jugular placed percutaneous RVAD for treatment of severe RV failure after LVAD implantation provides superior early postoperative survival than traditional management techniques. These findings support broader implementation of this technique to further characterize its benefit.
