A Modified Grading System for Early Right Heart Failure Matches Functional Outcomes and Survival After Left Ventricular Assist Devices. Issue 2 (February 2021)

• Record Type: Journal Article
• Authors: Grandin, E. Wilson; Troutman, Gregory S.; Gulati, Arune A.; Zamani, Payman; Mazurek, Jeremy A.; Atluri, Pavan; Rame, J. Eduardo
• Is Part Of: ASAIO journal. Volume 67:Issue 2(2021)
• Publication Date: 2021-02
• Subjects: left ventricular assist device -- right heart failure -- inotrope -- survival; Artificial organs -- Periodicals; 617
• DOI: 10.1097/MAT.0000000000001203
• Languages: English
• ISSNs: 1058-2916

Abstract

Abstract : Early right heart failure (ERHF) remains a common complication after continuous-flow left ventricular assist device (cf-LVAD) and has been associated with increased mortality. The specific criteria used to define ERHF remain somewhat arbitrary. Correlating the degree of ERHF with outcomes after LVAD could inform a more clinically relevant definition. We identified 196 patients who underwent first durable cf-LVAD between 2008 and 2015 at a single center. Postimplant ERHF was graded as absent, mild (requiring inotropic support for 14–20 days), moderate (inotropes for ≥ 21 days), or severe (requiring unplanned RVAD at any time during the index hospitalization). ERHF was associated with clinical outcomes including 1 year survival and New York Heart Association (NYHA) class and 6 minute walk distance (6MWD) at 3 and 6 months. Survival was assessed using the Kaplan–Meier method with log-rank testing and multivariate Cox proportional-hazards modeling. Compared to patients without ERHF, those with mild ERHF had similar 1 year survival (hazard ratio [HR] 0.69, 95% confidence interval [CI]: 0.26–1.80, p = 0.45), while mortality was substantially increased in patients with moderate (HR 2.65, 95% CI: 1.27–5.54, p = 0.009) and severe ERHF (HR 8.16, 95% CI: 3.97–16.76, p < 0.0001). The severity of ERHF was associated with 6MWD at both 3 months ( p = 0.001) and 6 months ( p = 0.013). The relationship between ERHF and postimplant survival and functional status persisted in multivariate modeling. A simple, modified grading system for ERHF severity is strongly associated with 1 year survival and functional capacity after cf-LVAD. These results argue against using a binary definition for ERHF and suggest the need to modify definition of ERHF severity.