Survival and Predictors of Mortality in Patients Undergoing RVAD Explant in IMACS.
Patel A, Grafton G, Tita C, Hannawi B, Selektor Y, Chamogeorgakis T, Apostolou D, Lanfear DE, Williams CT, Nemeh HW, and Cowger JA. Survival and Predictors of Mortality in Patients Undergoing RVAD Explant in IMACS. Journal of Heart and Lung Transplantation 2020; 39(4):S25-S26.
J Heart Lung Transplant
Purpose: Survival in patients requiring RVAD support is known to be poor. However, outcomes in those undergoing subsequent RVAD explant and predictors of mortality remain unknown. Methods: Of 16482 patients in IMACS, 723 patients had an isolated RVAD (n=29) or BiVAD (n=694) in place. Using Kaplan Meier methods, survival was estimated for the LVAD-only cohort and within the subgroup of RVAD/BiVAD patients with and without RVAD explant. Correlates of mortality in the RVAD explant group were identified with Cox multivariable regression. Results: Within the BiVAD group, 240 patients (33%) had an RVAD explant. Of these, 221 (92%) were performed for RV recovery, 17 (7.1%) for device malfunction and 2 (0.8%) were for other reasons. Survival at 1Y was 53±2.0% in the BiVAD group vs. 82±0.3% in LVAD-only patients (p<0.0001). Within the BiVAD group, patients undergoing RVAD explant had equivalent survival (1Y=54±2.5%) to those with ongoing BiVAD support (1Y=52±3.4%, p=0.54). BiVAD patients who died after RVAD explant were older, more likely to be BTT, and had higher preimplant creatinine (table). On multivariable analysis, older age, higher preimplant pulmonary systolic pressure, explant for RVAD dysfunction, and BTT indication predicted death after RVAD explant (table). Within the subgroup of BTT BiVAD (n=51) patients undergoing RVAD explant, survival was only 62% at 3 months. Conclusion: Patients undergoing RVAD explant, even for RV-recovery, have very poor survival. Patients who are transplant eligible with signs of RVAD dysfunction should be given urgent listing status. Rather than RVAD explant, BTT patients with signs of RV recovery may be better served with transplant.