Comparison of Percutaneous and Surgical Right Ventricular Assist Device Support Following Durable Left Ventricular Assist Device Insertion

EJ Coromilas, K Takeda, M Ando, M Cevasco, P Green, D Karmpaliotis, A Kirtane, VK Topkara, M Yuzefpolskaya, H Takayama, Y Naka, D Burkhoff, PC Colombo and AR Garan
J Card Fail 2018

BACKGROUND: Early right ventricular (RV) failure after LVAD increases morbidity and mortality. Percutaneous RVAD (pRVAD) support is an alternative to more invasive surgical RVAD (sRVAD).

METHODS: We retrospectively reviewed patients receiving isolated pRVAD or sRVAD after durable LVAD at our center between 2007-2018. Hemodynamic parameters before and after implantation and survival outcomes were compared among groups.

RESULTS: Nineteen patients received pRVAD and 21 received sRVAD. Hemodynamic parameters improved immediately with pRVAD; central venous pressure decreased (15.9+/-2.4 to 12.3+/-3.2 mmHg, p<0.001) and cardiac index increased (2.4+/-0.5 to 3.5+/-0.8 L/min/m(2), p<0.001). These were sustained following device removal and were similar to those with sRVAD. Patients with pRVAD required fewer blood transfusions and mechanically-ventilated days than with sRVAD. Among survivors, ICU and hospital days were fewer with pRVAD [21(16-27) vs. 34(27-46) ICU days, p=0.01; 43.5(30-66) vs. 91(62-111) hospital days, p=0.03]. There was no significant difference in 30-day mortality with pRVAD compared to sRVAD (21.1% vs. 42.9%, p=0.14), but there was a trend toward higher rate of discharge free from hemodialysis (73.7% vs. 47.6%, p=0.09).

CONCLUSIONS: Novel pRVAD systems for RV failure provide hemodynamic benefits comparable to sRVAD, are associated with less morbidity, and should be considered an alternative to sRVAD.

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