Antiangiotide

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.

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.

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