Right Heart Failure While on Left Ventricular Assist Device Support Is Associated with Primary Graft Dysfunction

Area of Science:

• Cardiology
• Transplantation Medicine
• Medical Devices

Background:

• Primary graft dysfunction (PGD) is a major complication after heart transplantation.
• Left ventricular assist devices (LVADs) are increasingly used as bridge-to-transplantation.
• Right heart failure (RHF) is a known complication of LVAD support.

Purpose of the Study:

• To investigate the association between post-LVAD RHF and the incidence of PGD.
• To determine the impact of RHF on short-term and long-term transplant outcomes.

Main Methods:

• Retrospective chart review of 141 patients who received heart transplants between 2010 and 2016.
• Patients were stratified based on the presence or absence of RHF while on LVAD support.
• Multivariable logistic regression analysis was used to adjust for confounding variables.

Main Results:

• 41 out of 141 patients developed RHF.
• The incidence of PGD was significantly higher in the RHF cohort (44% vs. 14%, p < 0.001).
• 30-day mortality (20% vs. 1%, p < 0.001) and 1-year mortality (22% vs. 6%, p = 0.013) were significantly higher in the RHF group.
• RHF was independently associated with a nearly fourfold increased risk of PGD (OR, 3.91; p = 0.003).

Conclusions:

• Post-LVAD RHF is a significant risk factor for PGD after heart transplantation.
• RHF is associated with increased mortality following cardiac transplantation.
• Early recognition and management of RHF in LVAD patients may improve transplant outcomes.