Timing Of RVAD Insertion and The Associated Outcomes in CF-LVAD Patients

Autor: Todd K. Rosengart, Andrew B. Civitello, Harveen K. Lamba, P. Li, O.H. Frazier, S. Oberton, Jeffrey A. Morgan, Leo Simpson, Reynolds M. Delgado, Joggy George, Ajith Nair, Faisal H. Cheema, Ziad Taimeh, Gabriel Loor, Y. Luo, J. Conroy
Rok vydání: 2018
Předmět:
Zdroj: Journal of Cardiac Failure. 24:S117-S118
ISSN: 1071-9164
DOI: 10.1016/j.cardfail.2018.07.430
Popis: Study Right ventricular assist devices (RVAD) are commonly used for severe right heart failure (RHF) after continuous flow left ventricular assist device (CF-LVAD) insertion. However, the timing of RVAD insertion and the associated outcomes in CF-LVAD patients remains unclear. This study evaluates the effect of timing of RVAD insertion on long-term outcomes of CF-LVAD patients. Methods We performed a retrospective review CF-LVAD implantations from Jan 2001 through Mar 2017 at our center. From this, we culled out patients who received an RVAD and divided this cohort into early insertion (≤24 hours after CF-LVAD placement) and delayed insertion (>24 hours and ≤30days after CF-LVAD placement) groups. We compared early and late outcomes in the two groups. Results Within the CF-LVAD placement cohort (n=692), 61 (8.82%) patients required RVAD for severe RHF, with 35 (57.4%) patients in the early insertion group and 26 (42.6%) in the delayed insertion group. The majority of patients received temporary-type RVADs (CentriMag=42, TandemHeart=3) while some received durable-type RVADs (HeartWare=5, HeartMateII=1, Abiomed5000=4, Jarvik2000=1, Thoratec PVAD=3, Biomedicus=1). The mean duration of RVAD support was 48.8 days. In the early group, 17 (48.6%) patients were successfully weaned vs. 10 (38.5%) in the delayed group (p=NS). Overall differences between the early and late group have been summarized in Table 1 . Thirty-day mortality was similar for early 19 (54.3%) vs. delayed group 15 (57.7%) (p=NS) (Figure 1). There was no significant difference between the two groups in successfully bridging to transplantation. The 12-month overall survival rate in early placement patients was 16.7% and 26.9% in the delayed placement patients (p=NS) (Figure 1). Conclusions In this cohort of patients, no significant differences were found between the early and delayed groups in length of stay or 30-day readmission rates. There is no effect of timing of RVAD insertion on long-term outcomes of CF-LVAD patients. Prospective randomized trials can be designed to answer this equipoise effectively.
Databáze: OpenAIRE
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