Longer Duration of Milrinone Associated with Higher Risk for Right Ventricular Failure Following Left Ventricular Assist Device Implantation in Stage D Heart Failure Patients

Background Milrinone is a phosphodiesterase inhibitor that is used for the management of end stage heart failure (HF) patients, either as a palliative treatment or as a bridge to advanced HF therapies. Left ventricular assist device (LVAD) implantation has become a mainstay of advanced HF therapies, due to the limited number of available hearts for transplant. Unfortunately, up to 20% to 40% of device implantations are complicated by right ventricular failure (RVF), which results in significant morbidity and mortality. We aimed to investigate whether the duration on milrinone infusion is an independent risk factor for RVF following LVAD implantation. Methods This was a retrospectively review of medical records. We included all adult with ACC/AHA stage D HF patients who underwent LVAD implantation at our institution between January, 2010 and December, 2018. Patients were divided into two groups, those on short term ( 30 days) milrinone infusion. The primary endpoint for this study was the incidence of severe RVF (need for RV assist device or inotropic support for more than 14 days after LVAD) within 30 days post LVAD implantation. Results Total of 104 patients underwent LVAD implantation. Short term (STM) group had 55 pts and long term (LTM) had 49 patients. There were no significant differences between STM and LTM patients at baseline demographic, echocardiographic and right heart catheterization data. Following LVAD implantation, 5 (9.1%) patients in the STM group versus 9 (18.4%) in the LTM group needed RVAD support, and, 9 (16.4%) patients versus 22 (44.9%) needed inotropic support for more than 14 days (Figure 1). Overall, 45 (43.3%) patients developed RVF. LTM patients had a higher incidence of RVF; OR= 5.04 (95% CI 2.18 - 11.68), P=0.0002. After adjusting for age, gender, baseline RV function, atrial fibrillation, coronary artery disease, cerebrovascular disease, chronic kidney disease, and diabetes mellitus, the OR was 6.33 (95% CI 2.51 - 15.93), P Conclusion Longer duration on inotropes was associated with significantly higher incidence of early right ventricular failure following LVAD implantation.