Late right heart failure during support with continuous-flow left ventricular assist devices adversely affects post-transplant outcome

BACKGROUND: Right heart failure (RHF) is an unresolved issue during continuous-flow left ventricular assist device (LVAD) support. Little is known about post-transplant outcomes in patients complicated by late RHF during LVAD support. METHODS: Between May 2004 and December 2013, 141 patients underwent cardiac transplantation after isolated LVAD bridging at our center. Late RHF was defined as heart failure requiring medical intervention >4 weeks after LVAD implantation. RESULTS: The patients' mean age was 53 ± 13 years, 82% were men, and 36% had an ischemic etiology. The mean duration of LVAD support before transplantation was 0.75 years. Late RHF developed in 21 patients (15%) during LVAD support. Of these patients, 11 were supported with inotropic agents at the time of transplantation. Patients with RHF had higher creatinine (1.6 ± 0.88 mg/dL vs 1.3 ± 0.67 mg/dL, p = 0.07), higher blood urea nitrogen (32 ± 17 mg/dL vs 24 ± 10 mg/dL, p = 0.0013), higher total bilirubin (0.96 ± 0.46 mg/dL vs 0.78 ± 0.42 mg/dL, p = 0.07), and lower albumin (3.8 ± 0.60 g/dL vs 4.1 ± 0.46 g/dL, p = 0.0019) at the time of transplantation compared with patients who did not develop RHF. In-hospital mortality was significantly higher in patients with late RHF during LVAD support (29% vs 6.7%, p = 0.002). Overall post-transplant survival rates were 87% at 1 year, 83% at 3 years, and 77% at 5 years. The 5-year post-transplant survival was significantly worse in patients who developed late RHF during LVAD support compared with survival in patients who did not develop RHF (26% vs 87%, p < 0.0001). CONCLUSIONS: Late RHF during LVAD support adversely affects post-transplant survival.