Abstract 4366819: Clinical outcomes in patients with early right ventricular failure during index admission after HeartMate 3 LVAD implantation

Background: Despite the survival benefit of durable left ventricular assist devices (LVAD) in patients with end stage heart failure, right ventricular failure (RVF) remains a prominent cause of morbidity and mortality. It remains unclear if the development of early RVF after LVAD implantation, a period of hemodynamic variability, adversely impacts long-term outcomes in the HeartMate 3 (HM3) population. Purpose: This study aimed to characterize HM3 LVAD recipients who developed early RVF and determine its clinical impact. Methods: A single-center retrospective analysis was performed of patients who underwent HM3 LVAD implantation from January 1, 2015, to December 31, 2021. Early RVF was defined as perioperative use of intravenous inotropic support ≥ 14 days or right ventricular assist device (RVAD) placement after LVAD implantation. Patients with and without RVF during index admission were compared. Cox proportional hazards modeling was performed to investigate the association between the presence of RVF with survival and heart failure (HF) readmission. Results: 273 patients underwent HM3 implantation during the study period. The average implant age was 58 years, 75% were men, and 78% were Black patients. Of the 273 patients, 145 (53%) had early RVF after LVAD implantation. History of hypertension was a predictor of early RVF (HR 1.75; 95% CI, 1- 3.05; p=0.049). There was no significant difference in survival in patients with and without early RVF (multivariate-adjusted HR 1.32; 95% CI, 0.85-2.05; p=0.215; Figure) at 6 years (median 3.8 years) of follow-up. Early RVF at index admission was also not associated with subsequent HF readmission (multivariate-adjusted HR 0.87; 95% CI, 0.56-1.35; p=0.542). Conclusion: Our findings suggest that despite early RVF during index HM3 LVAD implantation, there was no association with long term clinical outcomes. Future studies should focus on hemodynamic and clinical optimization of this population during the perioperative period to potentially reduce subsequent adverse events after hospital discharge.