Noninferior Outcomes between Central versus Percutaneous Right Ventricular Assist Device Support Immediately after LVAD Placement

Purpose Postoperatively, left ventricular assist device (LVAD) implantation can be complicated by right ventricular failure in up to 40% of patients. Typically, temporary right side mechanical circulatory support (MCS) necessitates re-sternotomy and central placement of pulmonary artery and right atrial cannulas. However, percutaneous right ventricular assist device (pRVAD) can be placed without need for reoperation. Minimal literature exists comparing pRVAD with surgical RVAD (sRVAD) in patients in right heart failure that underwent LVAD placement. We believe that these two techniques are equally efficacious and can produce similar outcomes. Methods Data from Penn State Hershey Medical Center was retrospectively reviewed. Characteristics and outcomes of patients receiving RVAD support during the same hospitalization as LVAD implant were evaluated. Results Between 2013 and 2019, 22 patients were identified who underwent LVAD implant and subsequent RVAD MCS. 14 patients required sRVAD (mean age 56), and 8 required pRVAD (mean age 54). 85% of sRVAD patients had support initiated intraoperatively at the time of LVAD insertion, while only 25 % of pRVAD patients had intraoperative support (range 0 to 9 days following LVAD implant). Despite later initiation of support in pRVAD patients, hospital mortality was similar between groups (57% vs 62% with sRVAD & pRVAD, respectively). Duration of RVAD MCS was similar between those who survived to RVAD explant (mean 16.7 days vs 17.8 days in 11 sSVR and 5 pSVR patients, respectively). Those who survived had similar total LOS (70 vs 69 days) and ICU LOS (54.0 vs 57.4 days). Interestingly, maximum CVP in the 24 hours following RVAD implant was found to be lower in only 21% of sRVAD patients, while it was reduced in 89% of pRVAD patients. In addition, among those who survived and did not receive a tracheostomy (6 surgical and 5 percutaneous), pRVAD patients had shorter mean duration of ventilation (13.2 days v 30.8 days). Rates of CRRT were similar (64% vs 62%), and average decrease in creatinine by postoperative day 3 was also similar (-0.02 vs 0.25). Conclusion Percutaneous RVAD is an effective method of right heart MCS that can avoid the morbidity of reintubation and general anesthesia in the operating room, and achieve comparable outcomes to surgically placed RVAD while avoiding return to the operating room.