Incidence of right heart failure and its impact on survival outcomes after implantable left ventricular assist device implantation

In Japan, median waiting time of heart transplantation (HT) is estimated as more than 5 years. Internationally, they report relatively high incidence of right heart failure (RHF) during left ventricular assist device (LVAD) support. However, the analysis based on nationwide survey in Japan is still limited. Therefore, we aimed to clarify the predictor and incidence of RHF after LVAD implantation in contemporary cohort, and its impact on their survival outcomes. Adult patients who underwent LVAD implantation at our institution from 2007 to 2023 were retrospectively reviewed. Those eventually weaned off and those bridged from paracorporeal VAD were excluded, and finally 178 patients were enrolled. We evaluated the incidence of RHF, post-LVAD survival, and predictors of RHF or on-device mortality. Five-year on-device survival was 78.5%. The incidence of early RHF was 3.4% and its cumulative incidence at 5 year was 22.1%. While 91.5% of the cohort underwent LVAD as BTT, post-LVAD survival was not significantly worse with RHF (p = 0.107). Cox regression analyses demonstrated preoperative severe TR and dilated phase of hypertrophic cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy were the independent predictors of RHF and on-device death (hazard ratio (HR) 8.59, 95% confidence interval (CI) 3.68-20.0, HR 2.62, 95% CI 1.08-6.34, respectively). The incidence of early RHF was 3.4% and its cumulative incidence at 5 year was 22.1%, which was relatively low. Although RHF was not significantly associated with worse 5-year survival after LVAD implantation, we would need a large, nation-wide study to further address this issue.