84 Treatment of refractory right heart failure after implantation of a left ventricular assist device. is the levitronix centrimag right heart support a solution

Introduction Right heart failure after left Ventricular Assist Device (LVAD) implantation is a severe complication, in extreme cases necessitating additional mechanical assist. We present our institutional experience with the Levitronix CentriMag used for right ventricular support commencing LVAD implantation with refractory right ventricular failure. Material and Methods Between March 2001 and November 2010 109 patients underwent implantation of long term, total implantable, continuous flow LVADs: 60 HeartMate II, 25 Jarvik 2000 and 24 HeartWare. All patients requiring right ventricular support were included (n=24), for which the Levitronix CentriMag continuous flow, paracorporeal device was used. The analysis included patient demographics as well as overall duration of support and outcome parameters, including survival at 30, 90 days and 1 year. Results 24 pts. underwent implantation, age 37.9±13.7 years, gender: M/F-15/9, underlying disease: dilated cardiomyopathy 22(92%), peripartum cardiomyopathy 1(4%), viral myocarditis 1(4%). Median duration of support: 28 days (5–146). 3(12.5%) pts. underwent heart transplantation (HTx) on RV support, 14(58.5%) underwent RVAD explantation. Of these, 3 underwent successful HTx, 4 recovered LV function and underwent successful LVAD explantation, 3 remain on continuing LVAD support, 4 patients died after RVAD explantation (post explantation day 1, months 3 and 4 and at 2 years), 7(29%) patients died during RV support. Median ITU/hospital stay: 19.5 days (6–145)/78.5 days (10–219). 30-day/90-day/1-year survival: 79%/71%/60%. 15(62.5%) patients were discharged from hospital after treatment. Median survival after procedure: 473.5 days (10–1917). Conclusion Levitronix CentriMag right ventricular support is an excellent option for post LVAD implantation treatment of refractory RV failure. It allows either bridging to transplantation or RV function improvement and provides an acceptable rate of survival.