Contemporary Outcomes Of Temporary Percutaneous Right Ventricular Support In A Heterogeneous Right Ventricular Failure Cohort
Danny Ramzy, Mark J. Kearns, Phil Chou, Elizabeth Passano, Laurence Czer.
Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Purpose Right ventricular failure occurs in a variety of clinical settings, and is associated with reduced survival. We sought to describe our recent clinical experience with two temporary percutaneous right ventricular assist devices (RVAD): TandemLife Protek Duo (TPD; TandemLife, Pittsburgh, PA), and Impella RP (Abiomed, Danvers, MA). Methods A prospectively collected institutional heart failure device registry was mined for clinical data related to TPD and Impella RP devices. Baseline demographic characteristics, etiology of heart failure, indication for RVAD support, and timing of implantation in relation to the onset of right ventricular (RV) failure were characterized for both temporary percutaneous RVADs. Specific clinical outcomes, including overall survival, time on temporary percutaneous RV support, device explant, and device exchanges were analyzed. Outcomes were further analyzed among the cohort of explanted patients. Results Between 2015-2018 19 TPD devices and 10 Impella RP devices were implanted. Indication for RV support included post-left ventricular assist device (LVAD) implantation RV failure, post-cardiotomy cardiogenic shock, and post-transplant (TPx) RV failure. Mean (median) device support duration for TPD was 16(12) days, and 5(4) days for Impella RP. Among TPD patients, 11(57.9%) were explanted, 4 (21.0%) died, and there were no device exchanges. Among Impella RP patients, 5 (50.0%) were explanted, 3 (30.0%) died, and 1 (10.0%) required device exchange. Among TPD patients explanted, 7(63.6%) recovered and were weaned, 3(27.2%) died, and 1(9.1%) required a durable RVAD. Among Impella RP patients explanted, 4(80.0%) recovered and were weaned, and 1(20.0%) required a durable RVAD. Conclusions RV failure, commonly encountered in surgical heart failure patients, is associated with reduced survival. Temporary percutaneous RVAD devices provide an attractive means of bridging to RV recovery. Multivariable and risk factor analyses to determine hazards correlated with indication for and timing of RV support, and support device are ongoing.
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