Is severe right ventricular failure in left ventricular assist device recipients a risk factor for unsuccessful bridging to transplant and post-transplant mortality.

BACKGROUND: Bridging to transplant with a left ventricular assist device (LVAD) can be limited by severe right ventricular failure (RVF). The focus of this study was to ascertain whether early implantation (< 24 hours) of a right ventricular assist device (RVAD) in patients with severe RVF improved survival and whether severe RVF adversely affected post-transplant survival.
METHODS: We conducted a 10-year review of our bridge to transplant experience using the Heartmate device (Thoratec, Pleasanton, CA, USA), studying patients who required an Abiomed RVAD (Abiomed, Danvers, MA, USA).
RESULTS: There were 243 patients who underwent LVAD implantation, of which 17 (7.0%) required an RVAD. Ten patients underwent early RVAD insertion (< 24 hours) while 7 underwent delayed insertion (> 24 hours). Bridging to transplant was successful in 11 (64.7%) RVAD patients versus 163 (72.1%) non-RVAD patients (p = 0.046). Of the 10 patients who underwent early RVAD insertion, 7 (70.0%) were successfully bridged. Of the 7 patients who underwent delayed RVAD insertion, 4 (57.1%) were successfully bridged (p < 0.001). There was no significant difference in post-transplant 1, 5, and 10-year survival between RVAD and non-RVAD patients (71.4%, 71.4%, and 71.4% for RVAD patients, vs 90.5%, 80.4%, and 78.5%, respectively, for non-RVAD patients; p = 0.366). Pretransplant RVAD support was not a risk factor for post-transplant mortality (p = 0.864).
CONCLUSIONS: Severe RVF adversely impacted bridging to transplant, although survival was improved with early RVAD insertion. The trend toward worse post-transplant survival in the RVAD cohort raises the possibility that if additional patients were evaluated, a difference in survival might be observed, suggesting the need for a multicenter analysis.