TY - JOUR
T1 - Incidence and risk factors of late right heart failure in chronic mechanical circulatory support
AU - Felix, Susanne E. A.
AU - Numan, Lieke
AU - Oerlemans, Marish I. F.
AU - Aarts, E.
AU - Ramjankhan, Faiz Z.
AU - Gianoli, Monica
AU - Asselbergs, Folkert W.
AU - de Jonge, Nicolaas
AU - van Laake, Linda W.
N1 - Funding Information: The collaboration project is co-funded by the PPP Allowance made available by Health-Holland, Top Sector Life Sciences & Health, to stimulate public-private partnerships (LVAD-LVAD, LSHM19035). Publisher Copyright: © 2023 The Authors. Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.
PY - 2023/7
Y1 - 2023/7
N2 - Background: Late right heart failure (LRHF) is a common complication during long-term left ventricular assist device (LVAD) support. We aimed to identify risk factors for LRHF after LVAD implantation. Methods: Patients undergoing primary LVAD implantation between 2006 and 2019 and surviving the perioperative period were included for this study (n = 261). Univariate Cox proportional hazards analysis was used to assess the association of clinical covariates and LRHF, stratified for device type. Variables with p < 0.10 entered the multivariable model. In a subset of patients with complete echocardiography or right catheterization data, this multivariable model was extended. Postoperative cardiopulmonary exercise test data were compared in patients with and without LRHF. Results: Nineteen percentage of patients suffered from LRHF after a median of 12 months, of which 67% required hospitalization. A history of atrial fibrillation (AF) (HR: 2.06 [1.08–3.93], p = 0.029), a higher preoperative body mass index (BMI) (HR: 1.07 [1.01–1.13], p = 0.023), and intensive care unit (ICU) duration (HR: 1.03 [1.00–1.06], p = 0.025) were independent predictors of LHRF in the multivariable model. A significant relation between the severity of tricuspid regurgitation (TR) and LRHF (HR: 1.91 [1.13–3.21], p = 0.016) was found in patients with echocardiographic data. Patients with LRHF demonstrated a lower maximal workload and peak VO2 at 6 months postoperatively. Conclusion: A history of AF, BMI, and longer ICU stay may help identify patients at high risk for LRHF. Severity of TR was significantly related to LRHF in a subset of patients.
AB - Background: Late right heart failure (LRHF) is a common complication during long-term left ventricular assist device (LVAD) support. We aimed to identify risk factors for LRHF after LVAD implantation. Methods: Patients undergoing primary LVAD implantation between 2006 and 2019 and surviving the perioperative period were included for this study (n = 261). Univariate Cox proportional hazards analysis was used to assess the association of clinical covariates and LRHF, stratified for device type. Variables with p < 0.10 entered the multivariable model. In a subset of patients with complete echocardiography or right catheterization data, this multivariable model was extended. Postoperative cardiopulmonary exercise test data were compared in patients with and without LRHF. Results: Nineteen percentage of patients suffered from LRHF after a median of 12 months, of which 67% required hospitalization. A history of atrial fibrillation (AF) (HR: 2.06 [1.08–3.93], p = 0.029), a higher preoperative body mass index (BMI) (HR: 1.07 [1.01–1.13], p = 0.023), and intensive care unit (ICU) duration (HR: 1.03 [1.00–1.06], p = 0.025) were independent predictors of LHRF in the multivariable model. A significant relation between the severity of tricuspid regurgitation (TR) and LRHF (HR: 1.91 [1.13–3.21], p = 0.016) was found in patients with echocardiographic data. Patients with LRHF demonstrated a lower maximal workload and peak VO2 at 6 months postoperatively. Conclusion: A history of AF, BMI, and longer ICU stay may help identify patients at high risk for LRHF. Severity of TR was significantly related to LRHF in a subset of patients.
KW - late right heart failure
KW - left ventricular assist device
KW - mechanical circulatory support
KW - risk factor
UR - http://www.scopus.com/inward/record.url?scp=85153508089&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/aor.14537
DO - https://doi.org/10.1111/aor.14537
M3 - Article
C2 - 37032516
SN - 0160-564X
VL - 47
SP - 1192
EP - 1201
JO - Artificial organs
JF - Artificial organs
IS - 7
ER -