J Eduardo Rame1, Francis D Pagani2, Michael S Kiernan3, Guilherme H Oliveira4, Edo Y Birati5, Pavan Atluri6, Ann Gaffey6, E Wilson Grandin7, Susan L Myers8, Craig Collum8, Robert L Kormos9, James K Kirklin8, Jeffrey J Teuteberg10. 1. Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Advanced Cardiac and Pulmonary Vascular Disease Programs, Jefferson University, Philadelphia, Pennsylvania, USA. 2. Cardiothoracic Surgery, University of Michigan, Ann Arbor, Michigan, USA. 3. Cardiovascular Medicine, Tufts University, Boston, Massachusetts, USA. 4. Division of Cardiovascular Sciences, Department of Internal Medicine and Heart and Vascular Institute, University of South Florida Morsani College of Medicine and Tampa General Hospital, Tampa, Florida, USA. 5. Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 6. Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 7. Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. 8. Cardiothoracic Surgery, University of Alabama, Birmingham, Alabama, USA. 9. Abbott, Abbott Park, Illinois, USA; Cardiovascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. 10. Cardiovascular Medicine, Stanford University, Stanford, California, USA. Electronic address: jeff.teuteberg@stanford.edu.
Abstract
BACKGROUND: A revised definition of right heart failure (RHF) for the Society of Thoracic Surgeons Intermacs database of left ventricular assist devices (LVADs) was introduced in June 2014. OBJECTIVES: The purpose of this study was to determine the prevalence and severity of RHF over time and the association of RHF status at 3 months with 12-month outcomes after LVAD. METHODS: All patients in Society of Thoracic Surgeons Intermacs with follow-up and supported at least 3 months with a continuous flow LVAD implanted between June 2, 2014 and March 31, 2017 without a simultaneous RVAD. RHF was defined as both documentation and manifestations of elevated central venous pressures. RESULTS: There were 6,118 patients included with an incidence of RHF at 3, 6, and 12 months postimplant categorized as mild in 5%, 6%, and 6% and moderate in 5%, 3%, and 3%, respectively. For those with no RHF at 3 months, there was a low incidence of subsequent RHF at 6 and 12 months. The lack of RHF at 3 months, compared with mild and moderate RHF, was associated with a lower 12-month cumulative incidence of mortality (6.9% vs 16.7% vs 28.1%; P < 0.0001) and a lower 12-month cumulative incidence of stroke (7.4% vs 9.5% vs 11.0%; P = 0.0095), gastrointestinal bleeding (14.8% vs 24.2% vs 23.6%; P < 0.0001), and rehospitalization (65.2% vs 73.2% vs 71.2%; P < 0.0001). CONCLUSIONS: In patients surviving 3 months with LVAD support alone, mild or moderate RHF occurred in nearly 1 of 10 patients at 12 months. Patients with late RHF had worse survival and a higher cumulative incidence of major adverse events.
BACKGROUND: A revised definition of right heart failure (RHF) for the Society of Thoracic Surgeons Intermacs database of left ventricular assist devices (LVADs) was introduced in June 2014. OBJECTIVES: The purpose of this study was to determine the prevalence and severity of RHF over time and the association of RHF status at 3 months with 12-month outcomes after LVAD. METHODS: All patients in Society of Thoracic Surgeons Intermacs with follow-up and supported at least 3 months with a continuous flow LVAD implanted between June 2, 2014 and March 31, 2017 without a simultaneous RVAD. RHF was defined as both documentation and manifestations of elevated central venous pressures. RESULTS: There were 6,118 patients included with an incidence of RHF at 3, 6, and 12 months postimplant categorized as mild in 5%, 6%, and 6% and moderate in 5%, 3%, and 3%, respectively. For those with no RHF at 3 months, there was a low incidence of subsequent RHF at 6 and 12 months. The lack of RHF at 3 months, compared with mild and moderate RHF, was associated with a lower 12-month cumulative incidence of mortality (6.9% vs 16.7% vs 28.1%; P < 0.0001) and a lower 12-month cumulative incidence of stroke (7.4% vs 9.5% vs 11.0%; P = 0.0095), gastrointestinal bleeding (14.8% vs 24.2% vs 23.6%; P < 0.0001), and rehospitalization (65.2% vs 73.2% vs 71.2%; P < 0.0001). CONCLUSIONS: In patients surviving 3 months with LVAD support alone, mild or moderate RHF occurred in nearly 1 of 10 patients at 12 months. Patients with late RHF had worse survival and a higher cumulative incidence of major adverse events.
Authors: Fawaz Alenezi; Taylor A Covington; Monica Mukherjee; Stephen C Mathai; Paul B Yu; Sudarshan Rajagopal Journal: Circ Res Date: 2022-04-28 Impact factor: 23.213
Authors: Thomas Schlöglhofer; Franziska Wittmann; Robert Paus; Julia Riebandt; Anne-Kristin Schaefer; Philipp Angleitner; Marcus Granegger; Philipp Aigner; Dominik Wiedemann; Günther Laufer; Heinrich Schima; Daniel Zimpfer Journal: Life (Basel) Date: 2022-03-20