Prolonged Use of Levitronix Right Ventricular Assist Device (RVAD) in Patients with Long Term Left Ventricular Assist Device (LVAD)

Kamran Kerimzade ¹, Syed Mohiyaddin ², Nathan Tyson ¹, Debamalaya Ray ¹, Vincenzo Ciaci ¹

¹ Morriston Hospital, Swansea, United Kingdom; ² Swansea University Medical School, Swansea, United Kingdom;

Date, time and location: 2018.05.27 10:30, Congress Hall, 2F–A

Abstract

Objective
Severe right ventricular failure after implantation of long-term LVAD (LTLVAD) is common and occasionally requires the need for right support. The choices for RVAD support are limited mainly by short term devices.

METHODS
7 published papers were looked up reviewing data including one with multicentre trial of patients who had LTLVAD and required Centrimag RVAD implantation. There were 423 patients, 73 had Heartmate I, 20 Thoratec PVAD, 43 Jarvik 2000, 12 HeartWare and 275 HeartMate II. Mean age was 38.6 (range13-59) years. 73.9% were male, 21.7% had ICM and 78,3% DCM. 64 had preoperative mechanical ventilation, 83 had IABP and37%had multiple inotropic support. 36.5% patients underwent early right VAD insertion (<24 hours) 26.1% delayed (>24hours) while 17.24% were moribound patients salvaged with BiVAD Centrimag as a bridge to decision and later on upgraded for a LTLVAD and required continuous support of RVAD Centrimag.

RESULTS

Postoperative mean ventilation time 4.7days, ICU stay of 12.3days and hospital stay was 22.8 days. Mean duration of LTLVAD and RVAD support was 212 (range 4-619 days) and 44 (range 6 to 207) days, respectively. Operative mortality was 17.4%., 78.3%patients had their RVAD explanted, 26.1% were bridged to transplant, 8.7% had full myocardial recovery and had LTLVAD explanted. 74 patients are ongoing. There was no incidence of pump failure or thrombosis. The vast majority of patients were mobilised and exercised out of bed while on BIVAD support.

CONCLUSION
Prolonged use of RVAD Centrimag appears to be safe and effective for recovery or bridge to transplantation in patients with severe right ventricular failure and LTLVAD. Retrospectively it appears BiVAD devices could be used for long term in patients waiting for a transplant beyond 6 months from analysing these papers.