Right Heart Failure and Survival after Less Invasive LVAD Implantation
Presented During: Welcome Reception and Poster Competition | Sponsored by: TransMedics
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Madeline Fryer is a resident in the Integrated Cardiothoracic Surgery program at the University of Rochester. She is an alumna of the University of Massachusetts Medical School and earned a Master of Medical Science in immunology from Harvard Medical School. Her primary interest is adult cardiac surgery with a particular focus on heart failure.
Friday, September 20, 2024: 5:00 PM - 6:30 PM
Omni King Edward Hotel
Description
Objective: Right heart failure after durable left ventricular assist device (LVAD) implantation has been associated with increased mortality. While sternal-sparing surgical techniques that do not open the pericardium overlying the right ventricle have been associated in some studies with lower rates of early right heart failure (RHF), associations between implantation technique and late RHF have not been well characterized. Here we report a large series of 334 patients undergoing less invasive (LIS) HeartMate3 (HM3; Abbott Laboratories) implantation via bilateral thoracotomies (BT) or left thoracotomy with upper hemi-sternotomy (UH). We describe early and late RHF events in this cohort, as well as their association with overall survival.
Methods: All patients at our institution undergoing HM3 implantation via BT or UH between February 28, 2017 and April 17, 2024 were included for analysis. Early right heart failure events, including RVAD placement, were identified by chart review of all included patients. Late RHF events were identified by query of our institutional Intermacs database according to definitions in the STS Intermacs User's Guide Version 6.1 and adjudicated by a cardiac surgeon as true late RHF through targeted chart review. Baseline characteristics and outcomes of patients supported on HM3 including age, BMI, comorbidities, prior sternotomy, year of implant, use of cardiopulmonary bypass, RVAD support, return to the operating room for bleeding, and late right heart failure were analyzed. Unadjusted survival of patients grouped by RVAD use were compared using Log Rank comparisons. Cox proportional hazards models were built using SPSS software.
Results: A total of 334 patients met criteria and were included for analysis, including 290 BT and 44 UH patients. Among this pooled cohort, median and maximum follow-up was 33.4 and 76.4 months, respectively. Overall survival at 60 months is 69.7%. (See Figure 1A). Early RHF occurred in 9.4% of patients, and 5.0% of patients required RVAD placement. When stratified by RVAD placement, survival for those not requiring RVAD was significantly better by Log Rank comparison (p = 0.032; see Figure 1B). Late RHF in this pooled cohort was also low overall with 34 events occurring in 27 unique patients, for a total of 8.0% of patients experiencing late RHF events.
Conclusions: This large, single-institution cohort of patients undergoing HM3 implantation via LIS approach demonstrates this strategy has excellent long-term survival results, with five-year overall survival of 69.7%. Early right heart failure (9.4%), RVAD use (5.0%), and late RHF (8.0%) is low in this series, and use of RVAD was associated with worse survival compared to no RVAD (p = 0.032) when compared by Log Rank comparison. Taken together, these data suggest that low incidence of early RHF, especially severe RHF requiring RVAD use, may contribute to the excellent long-term survival seen amongst HM3 patients implanted via LIS. Late RHF remains a significant problem amongst LVAD patients, and the effect of surgical implantation strategy on late right heart outcomes warrants further investigation. Future work should also include comparisons to patients with HM3 implanted via full sternotomy for further investigation into the effect of surgical approach on RHF and survival.
Authors
Madeline Fryer (1), Andrew Jones (1), Igor Gosev (1), Katherine Wood (1)
Institutions
(1) University of Rochester Medical Center, Rochester, NY
Methods: All patients at our institution undergoing HM3 implantation via BT or UH between February 28, 2017 and April 17, 2024 were included for analysis. Early right heart failure events, including RVAD placement, were identified by chart review of all included patients. Late RHF events were identified by query of our institutional Intermacs database according to definitions in the STS Intermacs User's Guide Version 6.1 and adjudicated by a cardiac surgeon as true late RHF through targeted chart review. Baseline characteristics and outcomes of patients supported on HM3 including age, BMI, comorbidities, prior sternotomy, year of implant, use of cardiopulmonary bypass, RVAD support, return to the operating room for bleeding, and late right heart failure were analyzed. Unadjusted survival of patients grouped by RVAD use were compared using Log Rank comparisons. Cox proportional hazards models were built using SPSS software.
Results: A total of 334 patients met criteria and were included for analysis, including 290 BT and 44 UH patients. Among this pooled cohort, median and maximum follow-up was 33.4 and 76.4 months, respectively. Overall survival at 60 months is 69.7%. (See Figure 1A). Early RHF occurred in 9.4% of patients, and 5.0% of patients required RVAD placement. When stratified by RVAD placement, survival for those not requiring RVAD was significantly better by Log Rank comparison (p = 0.032; see Figure 1B). Late RHF in this pooled cohort was also low overall with 34 events occurring in 27 unique patients, for a total of 8.0% of patients experiencing late RHF events.
Conclusions: This large, single-institution cohort of patients undergoing HM3 implantation via LIS approach demonstrates this strategy has excellent long-term survival results, with five-year overall survival of 69.7%. Early right heart failure (9.4%), RVAD use (5.0%), and late RHF (8.0%) is low in this series, and use of RVAD was associated with worse survival compared to no RVAD (p = 0.032) when compared by Log Rank comparison. Taken together, these data suggest that low incidence of early RHF, especially severe RHF requiring RVAD use, may contribute to the excellent long-term survival seen amongst HM3 patients implanted via LIS. Late RHF remains a significant problem amongst LVAD patients, and the effect of surgical implantation strategy on late right heart outcomes warrants further investigation. Future work should also include comparisons to patients with HM3 implanted via full sternotomy for further investigation into the effect of surgical approach on RHF and survival.
Authors
Madeline Fryer (1), Andrew Jones (1), Igor Gosev (1), Katherine Wood (1)
Institutions
(1) University of Rochester Medical Center, Rochester, NY