Abstract 4366910: Multicenter Model to Predict Right Heart Failure After HeartMate 3 Left Ventricular Assist Device Implantation

Abstract

Background: Right heart failure (RHF) is a serious complication of durable HeartMate 3 (HM3) left ventricular assist device (LVAD) therapy. We aimed to evaluate the incidence, predictors, and prognostic significance of RHF within 3 months following HM3 LVAD implantation among patients in a contemporary multicenter registry, utilizing preoperative imaging, hemodynamics, and medication variables in our analysis. Methods: Patients underwent HM3 LVAD implantation at 6 centers between 2015-2022. A multivariable logistic regression model was developed using least absolute shrinkage and selection operator (LASSO) for the variable selection process. Mechanical Circulatory Support-Academic Research Consortium definitions of early and late RHF were used. Results: Among 596 patients (median age 59 years, 25% female, 48% INTERMACS profiles 1 or 2), 195 (33%) developed RHF within 3 months of LVAD implantation. In multivariable analysis, the following preoperative variables were independently associated with an increased risk of RHF: severe right ventricular systolic dysfunction on echocardiogram (OR 1.78, p=0.036), VA ECMO (OR 3.45, p=0.002), and dobutamine use (OR 1.66, p=0.029). Additionally, standardized lower left ventricular end-diastolic diameter (OR 0.76 per SD increase, p=0.005) and higher mean pulmonary artery pressure (OR 1.23 per SD increase, p=0.032) were significantly associated with increased risk of RHF. Survival, censored for heart transplant and pump exchange, was significantly worse for patients experiencing RHF within 3 months compared to patients who did not develop this complication (75% vs. 90% at 1-year and 63% vs 71% at 4-years, p=0.003; Figure). Conclusions: RHF is common within the first 3 months of HM3 LVAD implantation and is associated with significantly greater mortality during long-term follow-up. We identified preoperative imaging, hemodynamics, and medication variables that can be used during evaluation and selection of candidates for LVAD therapy.