PLACE: Multicenter Study for Right Ventricular Failure on Mechanical Cardiocirculatory Supports

Area of Science:

• Cardiology
• Critical Care Medicine
• Mechanical Circulatory Support

Background:

• Isolated acute right ventricular failure (aRVF) carries a poor prognosis and often necessitates temporary mechanical cardiocirculatory support (tMCS).
• Understanding risk factors and outcomes in aRVF patients treated with tMCS is crucial for improving patient management.

Purpose of the Study:

• To analyze the outcomes and identify risk factors for mortality in patients with isolated aRVF treated with tMCS.
• To evaluate the efficacy and safety of various tMCS strategies in a large, international cohort.

Main Methods:

• Retrospective analysis of the international, multicenter PLACE registry (2000-2020).
• Inclusion of 644 patients with isolated aRVF treated with tMCS, including mechanical circulatory support (MCS) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO).
• Multivariable logistic regression to identify predictors of in-hospital and 3-month mortality.

Main Results:

• The most common causes of aRVF were post-LVAD implantation and postcardiotomy shock.
• Weaning from tMCS was successful in 70.5% of patients; multiorgan failure was the primary cause of death on support (50.5%).
• In-hospital and 3-month mortality rates were 45% and 48.4%, respectively. Age, aRVF from pulmonary hypertension, high bilirubin, and oliguria/anuria were risk factors for mortality, while aRVF post-LVAD was associated with lower early mortality.

Conclusions:

• Temporary mechanical cardiocirculatory support is associated with in-hospital and 3-month mortality rates below 50% in patients with isolated aRVF.
• Pre-implantation factors including age, organ function, and specific tMCS type significantly influence mortality risk.
• aRVF following LVAD implantation appears to be associated with a more favorable early prognosis compared to other etiologies.