Timing of Right Heart Failure after Left Ventricular Assist Device is Associated with Survival after Heart Transplantation

Purpose Right heart failure (RHF) after left ventricular assist device (LVAD) occurs in a spectrum of severity and can occur both early and late after implant. Our recent work demonstrated that patients requiring IS after LVAD have reduced survival following heart transplant (OHT), but whether this extends to patients with early and late RHF is unknown. Methods We queried the UNOS registry from 1/00 - 9/17 for adults bridged to OHT with LVAD, excluding those with total artificial heart, dual-organ transplant, prior transplant, or congenital heart disease. We divided patients into 4 groups based on the need for IS at listing and at OHT: 1) No RHF = LVAD; LVAD, 2) early RHF = LVAD + IS; LVAD, 3) persistent RHF = LVAD + IS; LVAD + IS, and 4) late RHF = LVAD; LVAD + IS. We compared 1-year post-OHT survival using the Kaplan-Meier method and Cox proportional hazards models. Results Among 5080 patients bridged to OHT with LVAD, 4348 (86%) had no RHF, 343 (7%) early RHF, 194 (4%) persistent RHF, and 195 (4%) late RHF. Compared to patients without RHF at the time of OHT, those with persistent and late RHF had similar creatinine and total bilirubin but a higher proportion of ventilator support and lower Karnofsky performance scores (Table). Compared to patients with no RHF, 1-year post-OHT survival was similar for patients with isolated early RHF but was significantly lower among those with persistent and late RHF, and this relationship persisted in multivariate modeling (Figure). Conclusion Patients with persistent or late RHF requiring IS after LVAD have reduced post-OHT survival, similar to patients bridged with BiVAD.