Use of percutaneous mechanical circulatory support for right ventricular failure

Abstract

AbstractBackgroundUtilization of right ventricular mechanical circulatory support (RV‐MCS) devices has been limited by a lack of recognition of RV failure as well as a lack of availability and experience with RV‐MCS.AimsWe report a single‐center experience with the use of percutaneous RV‐MCS and report predictors of adverse outcomes.MethodsThis was a single‐center retrospective cohort study. Data from consecutive patients who received RV‐MCS for any indication between June 2015 and January 2022 were included. Data on baseline comorbidities, hemodynamics, and laboratory values were collected. The primary outcome was in‐hospital mortality analyzed as a logistic outcome in a multivariable model. These variables were further ranked by their predictive value.ResultsAmong 58 consecutive patients enrolled, the median age was 66 years, 31% were female and 53% were white. The majority of the patients (48%) were hospitalized for acute on chronic heart failure. The majority of the patients were SCAI SHOCK Stage D (67%) and 34 (64%) patients had MCS placed within 24 h of the onset of shock. Before placement of RV‐MCS, median central venous pressure (CVP) and RV stroke work index were 20 mmHg and 8.9 g m/m2, respectively. Median serum lactate was 3.5 (1.6, 6.2) mmol/L. Impella RP was implanted in 50% and ProtekDuo in the remaining 50%. Left ventricular MCS was concomitantly used in 66% of patients. Twenty‐eight patients (48.3%) died. In these patients, median serum lactate was significantly higher (4.1 [2.3, 13.0] vs. 2.2 [1.4, 4.0]  mmol/L, p = 0.007) and a trend toward higher median CVP (24 [18, 31] vs. 19 [14, 24] mmHg, p = 0.052). In the multivariable logistic model, both serum lactate and CVP before RV‐MCS placement were independent predictors of in‐hospital mortality. Serum lactate had the highest predictive value.ConclusionIn our real‐world cohort, 52% of patients treated with RV‐MCS survived their index hospitalization. Serum lactate at presentation and CVP were the strongest predictors of in‐hospital mortality.