The Impact of Preoperative Right Ventricular Dysfunction and Ventricular Arrhythmias on Left Ventricular Assist Device Outcomes.

Abstract

Ventricular arrhythmias (VA) are common in patients being evaluated for left ventricular assist devices (LVADs) but the impact of comorbid right ventricular dysfunction (RVD) on outcomes after LVAD is not known. We performed a single-center, retrospective cohort study of patients undergoing LVAD implantation from 2005 to 2021. Patients were stratified by VA history before LVAD into no VA, low burden VA (LBVA), or clinically significant VA (CSVA) groups. Right ventricular function was assessed by baseline echo. Time-to-event analyses were used with a primary outcome of all-cause mortality. Secondary outcomes were implantable cardioverter-defibrillator (ICD) shock, rehospitalization, and postoperative complications related to RV failure. A total of 761 patients were included, of which 442 (58%) had no VA, 120 (16%) had LBVA, and 199 (26%) had CSVA. The mean age was 57 and 584 (77%) of patients were male. Within the CSVA group, mortality was higher in those with baseline RVD (hazard ratio [HR] = 1.6, confidence interval [CI] = 1.1-2.5). Clinically significant VA and renal dysfunction were associated with mortality on Cox proportional hazards modeling. Implantable cardioverter-defibrillator shocks after LVAD were more common in those with LBVA or CSVA. There was no difference in 6-month rehospitalization between groups. Patients with a history of CSVA undergoing LVAD implantation are at increased risk for mortality and this risk is predominantly seen in those with comorbid RVD.