(811) Incidence of Right Ventricular Dysfunction in Lvad Patients Bridged with High Dose Inotropes

PurposeAdvanced heart failure is associated with poor quality of life and can progress to cardiogenic shock. Continuous inotropes can serve to stabilize patients while further advanced therapies can be considered. For those patient's being bridged to LVAD, right ventricular assessment is essential as inotropes may supply biventricular support without altering ventricular interdependence, which may be compromised post LVAD placement.MethodsWe retrospectively reviewed all patients undergoing durable LVAD implant from 2018-2022. Thirty eight patients were included in this analysis.ResultsThirty patients on continuous inotropes (CI) and 8 not on inotropes(NI) were implanted with LVAD during this time. Temporary MCS(tMCS) was required in 21 CI and all 8 NI patients. Mean PAPI pre tMCS was similar at 2.4 in the CI group and 2.3 in the NI group, while mean PAPI post tMCS in the CI group was 2.9 as compared to 5.25 in the NI group. Post LVAD PAPI was similar at 2.0 for both groups. Mean days of post LVAD inotrope use was shorter in the CI group at 11 vs 15 days. Survival to discharge in the CI group was 93%, with 83% 3-months and 66.7% 6-month survival. In the NI group 100% survived to discharge, 87.5% 3-month, and 71.4% 6-month survival. Further breakdown by inotrope dose (table 1) reveals that the high dose inotrope group had the highest morbidity and lowest survival.ConclusionThe use of inotropes is common to stabilize advanced heart failure patients in acute decompensated heart failure as a bridge to LVAD. Our experience underscores the importance of timely mechanical unloading and avoidance of high-dose vasoactive drugs in the management of these tenuous patients. While tMCS can augment these outcomes, we see that biventricular dysfunction is dynamic and with better outcomes when addressed early. Advanced heart failure is associated with poor quality of life and can progress to cardiogenic shock. Continuous inotropes can serve to stabilize patients while further advanced therapies can be considered. For those patient's being bridged to LVAD, right ventricular assessment is essential as inotropes may supply biventricular support without altering ventricular interdependence, which may be compromised post LVAD placement. We retrospectively reviewed all patients undergoing durable LVAD implant from 2018-2022. Thirty eight patients were included in this analysis. Thirty patients on continuous inotropes (CI) and 8 not on inotropes(NI) were implanted with LVAD during this time. Temporary MCS(tMCS) was required in 21 CI and all 8 NI patients. Mean PAPI pre tMCS was similar at 2.4 in the CI group and 2.3 in the NI group, while mean PAPI post tMCS in the CI group was 2.9 as compared to 5.25 in the NI group. Post LVAD PAPI was similar at 2.0 for both groups. Mean days of post LVAD inotrope use was shorter in the CI group at 11 vs 15 days. Survival to discharge in the CI group was 93%, with 83% 3-months and 66.7% 6-month survival. In the NI group 100% survived to discharge, 87.5% 3-month, and 71.4% 6-month survival. Further breakdown by inotrope dose (table 1) reveals that the high dose inotrope group had the highest morbidity and lowest survival. The use of inotropes is common to stabilize advanced heart failure patients in acute decompensated heart failure as a bridge to LVAD. Our experience underscores the importance of timely mechanical unloading and avoidance of high-dose vasoactive drugs in the management of these tenuous patients. While tMCS can augment these outcomes, we see that biventricular dysfunction is dynamic and with better outcomes when addressed early.