For a study, researchers sought to explore the natural history of post- left ventricular assist device (LVAD) right heart failure (RHF) and the associated risk factors and outcomes. Patients were included in the study if they had a continuous flow LVAD implanted between June 2, 2014, and June 30, 2016, and were registered in the Interagency Registry for Mechanically Assisted Circulatory Support/Society of Thoracic Surgeons Database. The incidence of RHF, as well as its determinants, as well as survival following RHF were analyzed. Elevated central venous pressure, peripheral edema, the presence of ascites, and the usage of inotropes were the RHF signs that were subjected to independent analyses. The outcomes showed that the prevalence of RHF after one month was 24% among 5,537 LVAD recipients (mean 57±13 years, 49% destination therapy, and support 18.9 months). About 5.3% of these people still had RHF symptoms after a year. In contrast, de novo RHF was initially diagnosed at 3 months, and it happened in 5.1% of patients and continued to affect 17% of these patients at 12 months. At 6 months, it occurred in 4.8% of patients and continued to affect 25% of patients at 12 months. A higher preimplant blood urea nitrogen (odds ratios of 1.03–1.09 per 5 mg/dL increase; P<0.0001), a history of tricuspid valve repair or replacement (odds ratios of 2.01–10.09; P<0.001), severely depressed right ventricular systolic function (odds ratios of 1.17–2.20; P=0.004), and centrifugal versus axial LVAD (ORs,1.15–1.78; P=0.001) represented risk factors for RHC incidence at 3 months. Patients with persistent RHF at 3 months had the lowest 2-year survival rate (57%), while patients with de novo RHF or RHF that resolved by 3 months had more favorable survival outcomes (75% and 78% at 2 years, respectively; P<0.001). Patients with de novo RHF or RHF that resolved by 3 months had more favorable survival outcomes. RHF at 1 or 3 months post-LVAD was a common and frequently temporary illness, which, if cleared, was associated with a somewhat positive prognosis. These findings were drawn from a study conducted in the United States. On the other hand, de novo, late RHF after LVAD (>6 months), was related to higher mortality and more likely to be a permanent condition. RHF assessment and risk classification in LVAD patients could be performed using the 1-, 3-, and 6-month periods, respectively.

Source – ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.121.008706