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Late right heart failure predictors after left ventricular assist device implantation

Session Poster Session 2

Speaker Oscar Gonzalez Fernandez

Event : ESC Congress 2019

  • Topic : heart failure
  • Sub-topic : Ventricular Assist Devices
  • Session type : Poster Session

Authors : O Gonzalez Fernandez (Madrid,ES), N Bouzas Cruz (Newcastle upon Tyne,GB), C Ferrera Duran (Madrid,ES), A Woods (Newcastle upon Tyne,GB), N Robinson-Smith (Newcastle upon Tyne,GB), S Tovey (Newcastle upon Tyne,GB), G Macgowan (Newcastle upon Tyne,GB), S Schueler (Newcastle upon Tyne,GB)

Authors:
O. Gonzalez Fernandez1 , N. Bouzas Cruz2 , C. Ferrera Duran3 , A. Woods2 , N. Robinson-Smith2 , S. Tovey2 , G. MacGowan2 , S. Schueler2 , 1University Hospital La Paz, Cardiology - Madrid - Spain , 2Freeman Hospital, Cardiothoracic - Newcastle upon Tyne - United Kingdom , 3Hospital Clinic San Carlos - Madrid - Spain ,

Citation:
European Heart Journal ( 2019 ) 40 ( Supplement ), 972

Background: Right heart failure (RHF) after left ventricular assist device (LVAD) implantation is a significant cause of morbidity and mortality. While multiple predictors of early RHF have been described, information on late RHF is scarce. The aim of this study was to identify predictors of late RHF in LVAD patients.

Methods: A retrospective analysis of all adult patients who underwent HeartWare-VAD implantation for ischemic heart disease or non-ischemic dilated cardiomyopathy in a single centre was performed. Late RHF was defined as RHF requiring hospitalization and medical treatment after 30 days of LVAD implantation.

Results: A total of 16 (10.3%) patients from 156 implantations developed late RHF. Patients developing late RHF were older at time of surgery, 56.7±6.9 vs 49.5±12.5 years; p<0.01. A significantly higher rate of moderate or severe tricuspid regurgitation before implantation was found in patients presenting with late RHF, 81.2% vs 33.5%; p<0.001. Several echocardiographic parameters at discharge post-implant, such as mitral regurgitation, demonstrated a strong association with late RHF. A multivariate Cox proportional-hazards regression analysis (table 1) revealed that significant pre-operative tricuspid regurgitation (moderate or severe) was the strongest predictor of late RHF development after LVAD surgery (HR 5.50, 95% CI [1.34–22.58]; p=0.02). Significant mitral regurgitation post-implantation and older age also predicted late RHF development.

Conclusions: Pre-operative significant tricuspid regurgitation and mitral regurgitation after implantation predict the occurrence of late RHF. Prospective studies are needed to determine whether tricuspid valve interventions may reduce late RHF.

Multivariate Cox proportional-hazards analysis for late right heart failure
VariableHazard ratio95% confidence intervalP-value
Tricuspid regurgitation- moderate or severe5.501.34–22.580.02
Mitral regurgitation (discharge)- moderate or severe3.541.14–11.020.03
Age1.071.01–1.140.03
Right ventricular basal diameter1.140.43–3.030.79
Right ventricular fractional area change0.980.87–1.100.79
Multivariate analysis showing predictors of late right heart failure according to a multivariate model.
Late RHF according to TR severity

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