University of Utah Health & School of Medicine, Salt Lake City (C.J.K., O.W.-P., C.H.S., J.S., S.H.M., A.K., E.M.G., J.C.F., S.G.D.).
National and Kapodistrian University of Athens, Faculty of Medicine, Greece (C.J.K., S.G.D.).
Circ Heart Fail. 2022 Jun;15(6):e008706. doi: 10.1161/CIRCHEARTFAILURE.121.008706. Epub 2022 Jun 6.
Our current understanding of right heart failure (RHF) post-left ventricular assist device (LVAD) is lacking. Recently, a new Interagency Registry for Mechanically Assisted Circulatory Support definition of RHF was introduced. Based on this definition, we investigated natural history, risk factors, and outcomes of post-LVAD RHF.
Patients implanted with continuous flow LVAD between June 2, 2014, and June 30, 2016 and registered in the Interagency Registry for Mechanically Assisted Circulatory Support/Society of Thoracic Surgeons Database were included. RHF incidence and predictors, and survival after RHF were assessed. The manifestations of RHF which were separately analyzed were elevated central venous pressure, peripheral edema, ascites, and use of inotropes.
Among 5537 LVAD recipients (mean 57±13 years, 49% destination therapy, support 18.9 months) prevalence of 1-month RHF was 24%. Of these, RHF persisted at 12 months in 5.3%. In contrast, de novo RHF, first identified at 3 months, occurred in 5.1% and persisted at 12 months in 17% of these, and at 6 months occurred in 4.8% and persisted at 12 months in 25%. Higher preimplant blood urea nitrogen (ORs,1.03-1.09 per 5 mg/dL increase; <0.0001), previous tricuspid valve repair/replacement (ORs, 2.01-10.09; <0.001), severely depressed right ventricular systolic function (ORs,1.17-2.20; =0.004); and centrifugal versus axial LVAD (ORs,1.15-1.78; =0.001) represented risk factors for RHC incidence at 3 months. Patients with persistent RHF at 3 months had the lowest 2-year survival (57%) while patients with de novo RHF or RHF which resolved by 3 months had more favorable survival outcomes (75% and 78% at 2 years, respectively; <0.001).
RHF at 1 or 3 months post-LVAD was a common and frequently transient condition, which, if resolved, was associated with relatively favorable prognosis. Conversely, de novo, late RHF post-LVAD (>6 months) was more frequently a persistent disorder and associated with increased mortality. The 1-, 3-, and 6-month time points may be used for RHF assessment and risk stratification in LVAD recipients.
我们目前对左心室辅助装置（LVAD）后右心衰竭（RHF）的了解还很欠缺。最近，机械循环辅助支持机构间登记处/胸外科医生协会数据库引入了一种新的 RHF 定义。基于这一定义，我们研究了 LVAD 后 RHF 的自然史、危险因素和结局。
纳入 2014 年 6 月 2 日至 2016 年 6 月 30 日期间植入连续流动 LVAD 并在机械循环辅助支持机构间登记处/胸外科医生协会数据库登记的患者。评估 RHF 的发生率和预测因素以及 RHF 后的生存情况。分别分析 RHF 的表现为中心静脉压升高、外周水肿、腹水和使用正性肌力药。
在 5537 名 LVAD 受者（平均年龄 57±13 岁，49%为终末期治疗，支持 18.9 个月）中，1 个月时 RHF 的发生率为 24%。其中，12 个月时 RHF 持续存在的比例为 5.3%。相比之下，在首次于 3 个月时发现的新发 RHF 中，有 5.1%持续存在，其中 17%持续存在 12 个月，4.8%于 6 个月时出现并持续存在 12 个月。较高的术前血尿素氮（OR，每增加 5mg/dL，1.03-1.09；<0.0001）、先前的三尖瓣修复/置换（OR，2.01-10.09；<0.001）、严重右心室收缩功能障碍（OR，1.17-2.20；=0.004）和离心式与轴流式 LVAD（OR，1.15-1.78；=0.001）是 3 个月时 RHC 发生率的危险因素。3 个月时持续存在 RHF 的患者 2 年生存率最低（57%），而新发 RHF 或 3 个月时 RHF 缓解的患者的生存率结果更为有利（分别为 75%和 78%，2 年；<0.001）。
LVAD 后 1 或 3 个月时的 RHF 是一种常见且常为一过性的疾病，如果缓解，预后相对较好。相反，LVAD 后新发的、晚期的 RHF（>6 个月）更常为持续性疾病，且与死亡率增加相关。1、3 和 6 个月的时间点可用于评估 LVAD 受者的 RHF 并进行风险分层。
