Incidence and Outcomes of Late Right Heart Failure Following Left Ventricular Assist Device Implantation

Late right heart failure (LRHF) following left ventricular assist device (LVAD) implantation remains an under-recognized complication with significant impact on patient outcomes. We conducted a retrospective cohort study of 183 consecutive LVAD patients at our institution between 2010 and 2024. LRHF was defined according to the 2020 Mechanical Circulatory Support Academic Research Consortium criteria. Clinical, echocardiographic, and perioperative parameters were analyzed with group comparisons and logistic regression, whereas outcomes were evaluated using Kaplan-Meier and competing-risk analyses. LRHF occurred in 17% of patients at a median of 8.8 months following LVAD implantation. Patients with LRHF had larger preoperative right ventricular (RV) basal diameters. Early right heart failure (ERHF) and RV basal diameter were independently associated with LRHF development. LRHF patients had significantly longer intensive care unit and hospital stays, higher rates of chest re-exploration, acute kidney injury, ventricular arrhythmias, and significantly more heart failure-related readmissions. Although overall survival was lower among LRHF patients, it did not reach statistical significance (p = 0.06). In conclusion, LRHF remains a frequent and morbid complication after LVAD implantation. Early recognition of RV dysfunction may help identify patients at risk of developing LRHF.