Adverse Events of Temporary Extracorporeal Right Ventricular Assist Devices Placed with Durable Left Ventricular Assist Devices

Purpose Right ventricular failure occurs in approximately 30% of patients who receive Left Ventricular Assist Devices (LVAD), of which less than 10% require Right Ventricular Assist Devices (RVAD). We present our outcomes of patients who required temporary RVAD support following LVAD implantation. Methods Clinical data was retrospectively assessed from our center between 2013 -2020. We analyzed cumulative adverse event rates; major bleeds, stroke, bacteremia, acute renal failure, driveline infection, device thrombosis, tracheostomy, limb ischemia, and in-hospital mortality. Outcomes were evaluated during index hospitalization after RVAD placement. Results 62 patients received an extracorporeal RVAD that was either staged, (n=20) or concurrent (n=42), after LVAD implant. Median age was 59 years, 66% were male. INTERMACS profile 1, 3% (n=2/62), profile 2, 18% (n=11/62), profile 3, 66% (n=41/62), profile 4 or above, 13% (n=8/62). Median duration of RVAD support was 30 days. Mortality rate during index hospitalization was 37% (n=23). Receiver operator characteristic analysis specified an optimal cutoff of 35 days (AUC=0.61) for the endpoint of cumulative adverse event rate and death. Shorter duration of RVAD support was associated with a higher incidence of adverse events and death (83% for RVAD < 35 days vs. 70% for RVAD > 35 days; P=0.034, Figure A). This was driven by a greater incidence of earlier death stratified by the cut-point of 22 days of RVAD support (AUC 0.61), where the mortality rate was 68% (13/19) at < 22 days and 23% (10/43) at > 22 days (P<0.001, Figure B). No significant difference in the combined endpoint was observed in patients who underwent either staged or concurrent RVAD placement (P=0.30, Figure C). Conclusion RVAD placement post LVAD implant is associated with considerable morbidity and mortality. Mortality rates were higher earlier in the course of RVAD support and later declined, though the risk of adverse events remained the same despite RVAD duration. Right ventricular failure occurs in approximately 30% of patients who receive Left Ventricular Assist Devices (LVAD), of which less than 10% require Right Ventricular Assist Devices (RVAD). We present our outcomes of patients who required temporary RVAD support following LVAD implantation. Clinical data was retrospectively assessed from our center between 2013 -2020. We analyzed cumulative adverse event rates; major bleeds, stroke, bacteremia, acute renal failure, driveline infection, device thrombosis, tracheostomy, limb ischemia, and in-hospital mortality. Outcomes were evaluated during index hospitalization after RVAD placement. 62 patients received an extracorporeal RVAD that was either staged, (n=20) or concurrent (n=42), after LVAD implant. Median age was 59 years, 66% were male. INTERMACS profile 1, 3% (n=2/62), profile 2, 18% (n=11/62), profile 3, 66% (n=41/62), profile 4 or above, 13% (n=8/62). Median duration of RVAD support was 30 days. Mortality rate during index hospitalization was 37% (n=23). Receiver operator characteristic analysis specified an optimal cutoff of 35 days (AUC=0.61) for the endpoint of cumulative adverse event rate and death. Shorter duration of RVAD support was associated with a higher incidence of adverse events and death (83% for RVAD < 35 days vs. 70% for RVAD > 35 days; P=0.034, Figure A). This was driven by a greater incidence of earlier death stratified by the cut-point of 22 days of RVAD support (AUC 0.61), where the mortality rate was 68% (13/19) at < 22 days and 23% (10/43) at > 22 days (P<0.001, Figure B). No significant difference in the combined endpoint was observed in patients who underwent either staged or concurrent RVAD placement (P=0.30, Figure C). RVAD placement post LVAD implant is associated with considerable morbidity and mortality. Mortality rates were higher earlier in the course of RVAD support and later declined, though the risk of adverse events remained the same despite RVAD duration.