RIGHT VENTRICULAR ASSIST DEVICE SUPPORT AS TREATMENT FOR ADVANCED RIGHT HEART FAILURE: TREATMENT STRATEGIES AND ANALYSIS OF OUTCOMES

Background and Aim: RotaFlow (Getinge) system, used as temporary right ventricular assist device (t-RVAD), has been investigated as treatment for refractory right heart failure (RHF). Methods: We retrospectively analysed 42 consecutive adult patients who underwent t-RVAD implantation at our institution, between 2009 and 2024 (male 67%; age 60.1±11.6 years). Indications for support were: failure to wean from cardiopulmonary bypass in the setting of post-cardiotomy cardiogenic shock (45%) and primary donor graft failure (33%), post-durable LVAD (19%), and post-acute myocardial infarction (3%). Results: Mean duration of support was 9 ± 8 days (range: 1-29 days) with a mean flow of 3.2±0.8 lpm. Femoral vein to pulmonary artery setting was established in 67% of cases, with interposition of a Dacron graft and tunnelling of the outflow cannula through the left 3rd intercostal space in 79% of them; direct right atrium inflow was used in 24% and a ProtekDuo cannula was adopted in 7% of cases. An oxy-RVAD was set in 43% of overall population. Rethoracotomy for bleeding was necessary in 15.4% of patients; no pulmonary embolism occurred. Mean intensive care unit (ICU) stay was 26.3±28.1 days. The success rate, in terms of survival on t-RVAD was 57.1%. Mean hospital stay was 39.1±41.8 days. Preoperative APACHE II, SOFA, SAPS II scorings were associated with increased 30-days mortality (16.3 vs. 12.5, p=0.05; 9 vs. 6.5, p=0.02; 41.6 vs. 34.7; p=0.03). Conclusions: t-RVAD support is still a valid option to treat advanced RHF. A pre-operative risk scoring may guide a proper timing for t-RVAD insertion.