The incidence, risk factors, and outcomes associated with late right-sided heart failure in patients supported with an axial-flow left ventricular assist device

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• 作者：Jonathan D. Rich ; MD^a ; ^{jonathan.rich@northwestern.edu} ; Igor Gosev ; MD^b ; Chetan B. Patel ; MD^c ; Susan Joseph ; MD^d ; Jason N. Katz ; MD ; MHS^e ; Peter M. Eckman ; MD^f ; Sangjin Lee ; MD^g ; Kartik Sundareswaran ; PhD^h ; Ahmet Kilic ; MDⁱ ; Brian Bethea ; MD^j ; Behzad Soleimani ; MD^k ; Brian Lima ; MD^l ; Nir Uriel ; MD^m ; Michael Kiernan ; MDⁿ ; on behalf of the Evolving Mechanical Support Research Group (EMERG) Investigators
• 关键词：late right-sided heart failure ; left ventricular assist device ; mechanical circulatory support ; predictors ; outcomes ; death ; HeartMate II
• 刊名：The Journal of Heart and Lung Transplantation
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：36
• 期：1
• 页码：50-58
• 全文大小：852 K
• 卷排序：36

文摘

Early right-sided heart failure (RHF) after left ventricular assist device (LVAD) implantation is associated with increased mortality, but little is known about patients who develop late RHF (LRHF). We evaluated the incidence, risk factors, and clinical impact of LRHF in patients supported by axial-flow LVADs.MethodsData were analyzed from 537 patients enrolled in the HeartMate II (HM II; Thoratec/St. Jude) destination therapy clinical trial. LRHF was defined as the development of clinical RHF accompanied by the need for inotropic support occurring more than 30 days after discharge from the index LVAD implant hospitalization. Clinical variables, quality of life, rehospitalizations, and survival were compared between patients with and without LRHF.ResultsLRHF developed in 41 patients (8%), with a median time to LRHF of 480 days. A higher preoperative blood urea nitrogen and increased central venous pressure–to–pulmonary capillary wedge pressure ratio were independent predictors of LRHF. The Michigan and HMII RHF risk scores were both associated with an increased likelihood of LRHF (p < 0.05). Patients with LRHF had worse quality of life according to the Kansas City Cardiomyopathy Questionnaire (61 ± 26 vs 70 ± 21; p < 0.05), poorer functional capacity by 6-minute walk distance (275 ± 189 m vs 312 ± 216 m; p < 0.05), and more rehospitalizations (6 vs 3; p < 0.001). LRHF was associated with decreased survival (p < 0.001).ConclusionsLRHF is an important complication in patients with LVADs and is associated with worse quality of life, reduced functional capacity, more frequent hospitalizations, and worse survival compared with those without LRHF.