More Frequent Hospitalizations and Worse Quality of Life with Late Right Heart Failure Compared to Early Right Heart Failure after Left Ventricular Assist as Destination Therapy.
Teuteberg J, Hiesinger W, Cowger JA, Rich J, Najjar SS, Jacoski M, Markham D, and Rogers J. More Frequent Hospitalizations and Worse Quality of Life with Late Right Heart Failure Compared to Early Right Heart Failure after Left Ventricular Assist as Destination Therapy. Journal of Heart and Lung Transplantation 2020; 39(4):S91-S92.
J Heart Lung Transplant
Purpose: Right heart failure (RHF) is a common adverse event (AE) after left ventricular assist device (LVAD) implantation in destination therapy (DT) patients. However, the timing of RHF may have differential impact on outcomes, AEs and functionality in this population. Methods: All HVAD patients enrolled in the ENDURANCE and ENDURANCE Supplemental trials (n=604) were assessed for RHF as defined by Intermacs (IM) and separated into two groups: (1) early RHF (ERHF) - RHF prior to discharge, but not afterwards or (2) late RHF (LRHF) - RHF only after discharge. Patients were followed for 2 years. Results: Overall, patients with ERHF (n=176) and LRHF (n=33) had similar pre-implant characteristics: Mean Age 62.7 years, Male 75.6%, White 68.9%, Ischemic 52.2%, IM 1: 4.8%, and IM 2-3: 73.9%. Baseline hemodynamics were also similar: RA 11.6 mmHg, PA s/d/m 49.6/23.5 (32.6) mmHg, and PVR 3.0. There was no difference in 2-year survival in ERHF v. LRHF (64.2% v. 63.6%, p=0.96), despite more non-device infections in the ERHF group (Figure 1a), and significantly higher all-cause rehospitalizations in the LRHF group (4.1 vs 26.0 eppy, p<0.0001). Although baseline quality of life (QoL) and 6-minute walk (6MW) were similar, both were significantly worse at 3 and 12 months in LRHF (Figure 1b). Conclusion: Baseline characteristics, including hemodynamics, QOL and functional capacity were similar between ERHF and LRHF. LRHF is associated with more frequent all-cause hospitalizations, worse quality of life and functionality post-discharge despite a similar 2-year survival.