Factors associated with successful treatment with temporary right ventricular assist devices for right ventricular failure in recipients of HeartMate 3 left ventricular assist device

Abstract Background Right ventricular failure (RVF) requiring support with temporary right ventricular assist device (tRVAD) is an important determinant of mortality in recipients of durable left ventricular assist devices (LVAD). Factors associated with the success of tRVAD use in these patients are not well understood. Purpose The aim of this study is to describe factors, including haemodynamic and laboratory trends, associated with the success of tRVAD therapy in HeartMate 3 (HM3) LVAD recipients with RVF. Methods This single-center, retrospective study included all HM3 LVAD recipients with RVF receiving tRVAD from 2019 to 2024. Baseline characteristics, clinical outcomes, and haemodynamic and laboratory parameters were collected via chart abstraction. The latter were recorded at five time-points: post-operative days 0, 1, 2, one day before end of support, and last day of support. Successful therapy was defined as weaning and explant of tRVAD with survival to hospital discharge. We compared patients with successful tRVAD therapy to those who failed weaning and/or died in the hospital. The association between each variable and success of tRVAD therapy was studied with univariate and multivariate logistic regression. Results During the study period, of the 402 patients who underwent HM3 LVAD implantation, 66 had post-LVAD RVF requiring tRVAD (mean age 56 years, 27% female). tRVAD was successful in 37 (56%) patients. Patients with successful tRVAD therapy had lower body mass index (BMI) (p=0.01), lower prevalence of atrial arrhythmia (p=0.02), and more frequently received an upfront tRVAD strategy (p=0.02) (Table). Patients with successful tRVAD therapy less frequently needed reintubation (p=0.02) and renal replacement therapy (p0.01) (Table). The temporal trends of select haemodynamic and laboratory parameters are shown in the Figure. Significant trends were delta lactate between post-operative days 0 and 1 (p=0.04), delta RVAD flow between post-operative day 2 and day before end of support (p=0.02), and delta vasoactive-inotropic score between post-operative day 2 and day before end of support (p=0.04) (Figure). On logistic regression, factors associated with successful tRVAD therapy were age, BMI, and delta lactate in the first 24 hours (adjusted odds ratio aOR for each 1-year increase in age: 0.95, 95 % confidence interval CI 0.90-0.99; aOR for each 1-unit increase in BMI: 0.90, 95 % CI 0.81-0.98; aOR for each 0.1-unit decrease in lactate in the first 24 hours: 0.97, 95 % CI 0.93-0.99). Conclusions Identification of factors associated with successful tRVAD therapy is critical to guiding treatment strategies in post-LVAD RVF. Addressing baseline comorbidities such as obesity in LVAD recipients may impact outcomes of tRVAD therapy. Change in lactate in the first 24 hours appears to be a determinant of the success of tRVAD therapy, underlying the importance of aggressive haemodynamic support in the first 24 hours after tRVAD implantation.Table Figure