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Effect of Preoperative Tricuspid and/or Mitral Regurgitation on Development of Late Right-Sided Heart Failure After Insertion of the HeartWare Left Ventricular Assist Device

Lookup NU author(s): Dr Gareth Parry, Dr Guy MacGowanORCiD, Dr Stephan Schueler

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Abstract

© 2019Right-sided heart failure (RHF) after left ventricular assist device implantation is a significant cause of morbidity and mortality. Although multiple predictors of early RHF have been described, information on late RHF is scarce. The aim of this study was to identify predictors of late RHF in left ventricular assist device patients. A retrospective analysis of all adult patients who underwent HeartWare-ventricular assist device implantation as a bridge to transplantation in a single-centre was performed. Late RHF was defined as RHF requiring rehospitalization after 30 days of implantation. A total of 16 (10.3%) patients from 156 implantations developed late RHF. Median time to late RHF onset was 182.5 (interquartile range 105 to 618) days. Patients developing late RHF were older at surgery. A significantly higher rate of moderate or severe tricuspid regurgitation before implantation was found in patients presenting with late RHF (81.2% vs 33.5%; p <0.001). Several echocardiographic parameters at discharge postimplant, such as significant mitral regurgitation, demonstrated a strong association with late RHF. A multivariate Cox regression analysis revealed that significant preoperative tricuspid regurgitation was the strongest predictor of late RHF (hazard ratio 5.50, 95% confidence interval [1.34 to 22.58]; p = 0.02). Significant mitral regurgitation postimplantation and older age also significantly predicted late RHF. In conclusion, preoperative significant tricuspid regurgitation and mitral regurgitation after implantation predict the occurrence of late RHF.

Publication metadata

Author(s): Gonzalez-Fernandez O, Bouzas-Cruz N, Ferrera C, Woods A, Robinson-Smith N, Tovey S, Parry G, MacGowan GA, Schueler S

Publication type: Article

Publication status: Published

Journal: American Journal of Cardiology

Year: 2019

Volume: 125

Issue: 2

Pages: 236-243

Online publication date: 26/10/2019

Acceptance date: 01/10/2019

ISSN (print): 0002-9149

ISSN (electronic): 1879-1913

Publisher: Elsevier Inc.

URL: https://doi.org/10.1016/j.amjcard.2019.10.005

DOI: 10.1016/j.amjcard.2019.10.005

PubMed id: 31767121

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