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DOI: 10.1055/s-0035-1544488
Right Ventricular Recovery Induced by Temporary Right Ventricular Assist Device Support
Background: Right ventricular failure is a major cause of morbidity and mortality after left ventricular assist device (LVAD) implantation. The potential for right ventricular recovery induced by mechanical assistance and exact guidelines for right ventricular assist device (RVAD) weaning still need to be defined.
Methods: Between January 2008 and October 2013 a total of 584 adults preselected by echocardiography underwent long-term rotary blood pump implantation at our center. Sixty-nine patients required temporary RVAD insertion for treatment of right ventricular failure after the initiation of LVAD support.
Results: Thirty-three patients on RVAD reached candidacy for weaning after a median of 6 (range 1–36) days of full RVAD support. Four of them were non-weanable: one received heart transplantation after 24 days, 3 patients were successfully bridged to long-term implantable RVADs after 15, 50 and 154 days on temporary support, respectively. In 2 patients weaning was interrupted due to onset of sepsis and late tamponade (both died on RVAD after 25 and 39 days). Weaning patients (n = 27) required a median support duration of 20 (range 3–65) days. At last follow-up LVAD outpatients (n = 19, 13.2 ± 5.3 months, cumulative support 25 patient/years) showed stable right ventricular function after previous weaning from temporary RVAD.
Conclusion: In general, the outcomes of patients who require unplanned implantation of a temporary RVAD after LVAD insertion are still unsatisfactory.
However, once patients in our study had reached weaning candidacy, the procedural success rate rose to 90% with right ventricular myocardial recovery allowing weaning of over 80%.
Weaned patients achieve acceptable functional status, right ventricular function and LVAD flow in outpatient studies.
