Analysis of outcomes in patients with HeartMate 3 with and without right ventricular assist device support

IF 3.7 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

ESC Heart Failure Pub Date : 2025-06-25 DOI:10.1002/ehf2.15353

Vinh Q. Chau, Laura Coyle, Rachel Pedersen, Colleen Gallagher, Nicole Graney, Lisa Kukla, Robin Paliga, Gregory P. Macaluso, Sunil Pauwaa, William G. Cotts, Patroklos S. Pappas, Antone J. Tatooles, Nikhil Narang

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Abstract

Aims

Following HeartMate 3 (HM3) LVAD implantation, acute right heart failure necessitating temporary right ventricular assist device (tRVAD) support has not been extensively described. We examined clinical outcomes in patients with HM3 LVAD stratified by the need for tRVAD support.

Methods and results

This was a single-centre, retrospective study of patients who underwent primary HM3 implantation from 2018 to 2022. Patients were placed on tRVAD (concomitant or delayed) support due to clinical deterioration. The primary outcome was 1-year all-cause mortality following HM3 implantation using competing risk analysis with heart transplantation acting as the competing event. A matched cohort analysis was also performed to evaluate the primary outcome of patients with and without tRVAD support. Secondary outcomes included an analysis of risk of LVAD-related adverse events stratified by the presence of tRVAD. Of the 192 patients (median age 60 [49–68] years, 74% male, 37% white), 51 (26%) required tRVAD support. Compared with those with HM3 alone, the tRVAD group had a higher percentage of INTERMACS profile 1 or 2 (49% vs. 27%, P = 0.0005) and had higher rates of pre-operative VA-ECMO (28% vs. 5%, P < 0.0001). The tRVAD group had a higher 1-year all-cause mortality (33% vs. 3%, adjusted HR [95%CI]: 32.4 [9.51–110], P < 0.0001) compared with the HM3 alone group. In-hospital mortality for patients with tRVAD was 26% compared with 1% in patients with HM3 alone (P < 0.0001). In the matched cohort analysis, significantly higher risk of both stroke (HR [95% CI]: 5.75 [1.55–21.3], P = 0.009) and dialysis (HR [95% CI]: 13.4 (3.96–45.5), P < 0.0001) was observed in the tRVAD cohort. Compared with concomitant tRVAD support, the delayed tRVAD group did not have a significantly higher risk of adverse events.

Conclusions

In this large single-centre experience, patients undergoing HM3 LVAD requiring tRVAD support had significantly higher risks of adverse clinical outcomes.

Abstract Image

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有和没有右心室辅助装置支持的HeartMate 3患者的结局分析。

目的：在HeartMate 3 （HM3）左室辅助装置植入后，急性右心衰需要临时右心室辅助装置（tRVAD）支持的情况尚未得到广泛报道。我们对HM3 LVAD患者的临床结果进行了研究，并根据是否需要tRVAD支持进行了分层。方法和结果：这是一项单中心、回顾性研究，研究对象是2018年至2022年接受HM3植入术的患者。由于临床恶化，患者接受tRVAD（伴随或延迟）支持。主要结局是HM3植入后的1年全因死亡率，采用竞争风险分析，心脏移植作为竞争事件。还进行了匹配队列分析，以评估有和没有tRVAD支持的患者的主要结局。次要结局包括lvad相关不良事件的风险分析，按tRVAD的存在分层。192例患者（中位年龄60[49-68]岁，男性74%，白人37%）中，51例（26%）需要tRVAD支持。与单独使用HM3的患者相比，tRVAD组具有更高的INTERMACS 1型或2型百分比（49%对27%，P = 0.0005），并且具有更高的术前VA-ECMO率（28%对5%，P）。结论：在这项大型单中心研究中，接受HM3 LVAD且需要tRVAD支持的患者具有显著更高的不良临床结果风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ESC Heart Failure Medicine-Cardiology and Cardiovascular Medicine

CiteScore

7.00

自引率

7.90%

发文量

461

审稿时长

12 weeks

期刊介绍： ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.