Clinical impact of an upfront RVAD strategy in HeartMate 3 LVAD recipients with severe early right ventricular failure requiring temporary mechanical support

Background

Left ventricular assist device (LVAD) recipients are at risk of developing early right ventricular failure (RVF), at times necessitating temporary mechanical support with right ventricular assist device (RVAD). The optimal timing of RVAD implantation in these patients is unclear. The aim of this study is to compare clinical outcomes between upfront RVAD (U-RVAD) and rescue RVAD (R-RVAD) in LVAD recipients with early RVF.

Methods

In this single-center retrospective cohort study, we included all patients who underwent HeartMate 3 (HM3) LVAD implant and required temporary RVAD for severe early RVF (30 days of LVAD implantation), from January 2019 to September 2024. U-RVAD was defined as RVAD use during the index LVAD operation. Baseline characteristics, perioperative outcomes, and mortality were compared between patients with U-RVAD and those with R-RVAD.

Results

During the study period, 402 patients underwent HM3 LVAD implantation, of whom 64 received temporary RVAD for severe early RVF (mean age 57 years, 27% female). Thirty-six received U-RVAD. The incidence of perioperative atrial arrhythmia and renal replacement therapy was lower in patients who received U-RVAD compared to those who received R-RVAD (p = 0.041 and 0.008, respectively). In-hospital and 90-day all-cause mortality occurred in 11 (31%) and 12 (33%) patients receiving U-RVAD and 16 (57%) and 19 (68%) patients receiving R-RVAD, respectively. On binary logistic regression, U-RVAD was associated with lower 90-day mortality (adjusted odds ratio 0.23, 95% confidence interval 0.06-0.80).

Conclusions

In HM3 LVAD recipients with severe early RVF requiring RVAD, U-RVAD was associated with improved clinical outcomes.