Early and Late Right Heart Failure Following LVAD Implantation: Epidemiology, Natural History and Outcomes. An Analysis of the STS INTERMACS Database

Purpose Current data regarding early and late right heart failure (RHF) post-LVAD is confounded by small populations and variable definitions of RHF. In 2014, a new INTERMACS (IM) definition of RHF was introduced. Based on this contemporary definition, we sought to investigate the epidemiology and natural history of RHF after LVAD. Methods Pts implanted with continuous flow LVAD between 6/2/14 and 6/30/16 were included. Survival stratified by presence of RHF was compared with Kaplan-Meier method. Results LVADs were implanted in 5,537 pts; mean age 57±13 yrs, 79% male, 49% destination therapy. Mean duration of support was 18.9m (8,734 pt-yrs). The proportion of pts suffering from RHF at 1 m was 24%. Among these pts, RHF persisted at 3, 6 and 12 m in 26.9%, 9.2% and 3.5%, respectively. De novo RHF at the above time points developed in 5.3%, 4.6% and 4.9% of pts, respectively. De novo RHF first identified at 3m persisted at 6m in 32% of cases, while de novo RHF first identified at 6m persisted at 12m in 31% of cases. Figure 1 depicts survival of pts based on RHF timing. Pts with no RHF had the highest survival and those with RHF which persisted throughout the follow-up had the lowest survival. Pts with RHF which resolved by 3m (Fig 1A) or by 6m (Fig 1B) had favorable survival. Survival was lower in pts with no early RHF at 1m but with de novo RHF at 3m (Fig 1A). Finally, in pts with no RHF at 3m but with de novo RHF at 6m (Fig 1B) survival was further decreased, approximating the one of the persistent RHF group. Conclusion Early RHF at 1m post-LVAD or de novo RHF occurring relatively early post-LVAD ( de novo RHF which occurs late post-LVAD (>3-6m) is more frequently a persistent disorder, which carries a significant risk of mortality. The 1, 3 and 6m-post-LVAD time points may be used for RHF assessment, risk stratification and potentially guide therapeutic interventions.