The Other Ventricle With Left Ventricular Assist Devices

Lynne Warner Stevenson, MD; Jordan R.H. Hoffman, MD; Jonathan N. Menachem, MD

Disclosures

J Am Coll Cardiol. 2022;78(23) 

In This Article

Prevalence of Right Heart Failure After LVAD

Rates of right heart failure (RHF) early after LVAD as measured by inotropic infusions after 7–14 days have varied from 15%-20%. Severe RHF as measured by the need for a right ventricular assist device (RVAD) occurs in 3.6% of patients during the surgery and in 2% within the next 14 days.[5] In 2013–2014, the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) revised criteria for RHF to a condition rather than an event, requiring both of the following: 1) evidence of elevated right heart filling pressures; and 2) clinical compromise defined by edema, ascites or palpable hepatomegaly, or hepatic or renal dysfunction. RHF is graded as severe if requiring RVAD, moderate with inotropic infusion, and mild otherwise.

The STS-INTERMACS report published in this issue of the Journal uses these criteria to provide a definitive reference for rates and outcomes of post-LVAD RHF.[6] At the 1-month milestone, 1 in 4 patients met the RHF definition (mostly moderate), decreasing to 1 in 10 by 3 months (mild and moderate), and 9% RHF at 12 months (more often mild). After the first 3 months, new diagnosis of RHF was rare and did not require RVAD.

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