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Heart failure etiology and risk of right heart failure in adult left ventricular assist device support: the European Registry for Patients with Mechanical Circulatory Support (EUROMACS)

BB. Løgstrup, P. Nemec, F. Schoenrath, J. Gummert, Y. Pya, E. Potapov, I. Netuka, F. Ramjankhan, ET. Parner, T. De By, H. Eiskjaer

. 2020 ; 54 (5) : 306-314. [pub] 20200618

Language English Country Great Britain

Document type Comparative Study, Journal Article, Multicenter Study

Persistent link   https://www.medvik.cz/link/bmc21012104

Objectives: Development of right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation remains a leading cause of perioperative morbidity, end-organ dysfunction and mortality. The objective of this study was to investigate whether the etiology of HF (ischemic HF versus non-ischemic HF) affects the risk of RVF within admission for LVAD implantation and during long-term follow-up. Methods: Between January 2011 and June 27, 2018, 3536 patients were prospectively enrolled into EUROMACS registry. Adult patients (>18 years) who received a first time LVAD were included. When excluding patients with congenital, restrictive, hypertrophic, valvular cardiomyopathies, and myocarditis the total population consisted of 2404 patients. Results: The total cohort consists of 2404 patients. Mean age were 55 years and predominantly male sex [2024 (84.2%)]. At the time of LVAD implantation 1355 (56.4%) patients had ischemic HF and 1049 (43.6%) patients had non-ischemic HF. The incidence of RVF was significantly increased in the non-ischemic HF group in the adjusted model (p = .026). The relative risk difference for RVF in patients with non-ischemic HF was in the adjusted model increased by an absolute value of 5.1% (95% CI: 0.61-9.6). In the ischemic HF group 76 patients (13.4%) developed late RVF and 62 patients (14.8%) in the non-ischemic HF group (p = .56). No differences in occurrence of RVF between HF etiology was observed after 2 and 4 years of follow-up, respectively (crude: p = .25, adjusted (sex and age) p = .2 and crude: p = .59, adjusted (sex and age) p = .44). Conclusions: Patients with non-ischemic HF undergoing LVAD had an increased incidence of early RVF compared to patients with ischemic HF in a large European population. During follow-up after discharge 14% patients developed RVF. We recommend HF etiology to be considered in identifying patients who are at risk for postoperative RVF after LVAD implantation.

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$a Løgstrup, Brian Bridal $u Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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$a Objectives: Development of right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation remains a leading cause of perioperative morbidity, end-organ dysfunction and mortality. The objective of this study was to investigate whether the etiology of HF (ischemic HF versus non-ischemic HF) affects the risk of RVF within admission for LVAD implantation and during long-term follow-up. Methods: Between January 2011 and June 27, 2018, 3536 patients were prospectively enrolled into EUROMACS registry. Adult patients (>18 years) who received a first time LVAD were included. When excluding patients with congenital, restrictive, hypertrophic, valvular cardiomyopathies, and myocarditis the total population consisted of 2404 patients. Results: The total cohort consists of 2404 patients. Mean age were 55 years and predominantly male sex [2024 (84.2%)]. At the time of LVAD implantation 1355 (56.4%) patients had ischemic HF and 1049 (43.6%) patients had non-ischemic HF. The incidence of RVF was significantly increased in the non-ischemic HF group in the adjusted model (p = .026). The relative risk difference for RVF in patients with non-ischemic HF was in the adjusted model increased by an absolute value of 5.1% (95% CI: 0.61-9.6). In the ischemic HF group 76 patients (13.4%) developed late RVF and 62 patients (14.8%) in the non-ischemic HF group (p = .56). No differences in occurrence of RVF between HF etiology was observed after 2 and 4 years of follow-up, respectively (crude: p = .25, adjusted (sex and age) p = .2 and crude: p = .59, adjusted (sex and age) p = .44). Conclusions: Patients with non-ischemic HF undergoing LVAD had an increased incidence of early RVF compared to patients with ischemic HF in a large European population. During follow-up after discharge 14% patients developed RVF. We recommend HF etiology to be considered in identifying patients who are at risk for postoperative RVF after LVAD implantation.
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$a Nemec, Petr $u Centre for Cardiovascular Surgery and Transplantation, Brno, Czech Republic
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$a Schoenrath, Felix $u Department of Cardiac, Thoracic and Vascular Surgery, German Heart Institute, Berlin, Germany $u DZHK (German Centre for Cardiovascular Research), Berlin, Germany
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$a Gummert, Jan $u Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
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$a Pya, Yuri $u Department of Adult Cardiac Surgery, National Research Center for Cardiac Surgery, Astana, Kazakhstan
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$a Potapov, Evgenij $u Department of Cardiac, Thoracic and Vascular Surgery, German Heart Institute, Berlin, Germany
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$a Netuka, Ivan $u Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
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$a Ramjankhan, Faiz $u University Medical Center Utrecht, Utrecht, The Netherlands
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$a Parner, Eric Thorlund $u Department of Public Health, Section for Biostatistics, Aarhus University, Aarhus, Denmark
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$a De By, Theo $u EUROMACS, European Registry for Patients with Mechanical Circulatory Support, EACTS, Windsor, UK
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$a Eiskjaer, Hans $u Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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