Preemptive Versus Reactive Use of a Right Ventricular Assist Device in HeartMate 3 Patients

Area of Science:

• Cardiology
• Mechanical Circulatory Support
• Heart Failure Management

Background:

• Severe right ventricular failure (RVF) is a significant complication following left ventricular assist device (LVAD) implantation.
• The optimal timing for initiating right ventricular assist device (RVAD) support in conjunction with LVADs remains a critical clinical question.

Purpose of the Study:

• To compare outcomes between preemptive RVAD insertion and reactive RVAD support in patients receiving a HeartMate 3 (HM3) LVAD.
• To identify the impact of RVAD timing on in-hospital mortality and long-term survival.

Main Methods:

• Retrospective review of 293 patients undergoing HM3 implantation between November 2014 and December 2022.
• Categorization into three groups: no RVAD, preemptive RVAD, and reactive RVAD.
• Comparison of in-hospital mortality and Kaplan-Meier survival analysis.

Main Results:

• In-hospital mortality was significantly higher in the reactive RVAD group (25.8%) compared to preemptive (3.0%) and no RVAD (2.2%) groups (p < 0.001).
• Three-year survival rates were comparable between preemptive RVAD (83.5%) and no RVAD (85.5%) groups, but markedly lower in the reactive RVAD group (46.6%) (p < 0.001).
• Reactive RVAD was identified as an independent risk factor for mortality (HR: 2.7, p < 0.001).

Conclusions:

• Preemptive RVAD insertion in select patients undergoing HM3 implantation is associated with improved survival outcomes.
• Delayed (reactive) RVAD support significantly increases mortality risk in patients experiencing RVF post-LVAD.
• This study supports a strategy of early consideration for RVAD in high-risk patients to mitigate adverse outcomes.