Abstract
BACKGROUND: Post-cardiotomy right ventricular failure (RVF) may be refractory to conservative measures and temporary mechanical circulatory support may be indicated. Little data exists regarding intraoperative post-cardiotomy RVF requiring concomitant right ventricular assist device (RVAD) placement. We undertook this study to analyze the impact of intraoperative RVF requiring concomitant RVAD placement. METHODS: This is a retrospective analysis of consecutive patients from 2018 to 2023 who experienced post-cardiotomy RVF and received intraoperative RVAD support. The primary outcome was patient survival to discharge. All patients were included in analysis, and none were excluded. RESULTS: From 2018 to 2023, 23 patients experienced intraoperative post-cardiotomy RVF and underwent concomitant RVAD placement. During this time frame, a total of 9,268 cardiac surgeries were performed at Baylor Scott & White Research Institute. Those who underwent concomitant RVAD placement had a median follow-up time of 152 [interquartile range (IQR), 52-418] days. Fifty-six percent (13/23) were male, and the median age was 67 (IQR, 60-72) years. Eight patients received isolated RVAD placement, 14 received RVAD and left ventricular assist device (LVAD), and 1 received RVAD with venoarterial (VA)-extracorporeal membrane oxygenation (ECMO) configuration. All RVADs consisted of the Protek Duo (LivaNova) cannula connected to an ECMO circuit. Two patients required two rounds of RVAD support. The median duration of RVAD support was 8 (IQR, 7-17) days. Survival to discharge was 78.3% (18/23), and the median length of stay was 30 (IQR, 20-41) days. Of the five in-hospital mortalities, 60% (3/5) of patients were unable to be weaned from extracorporeal life support. Overall patient survival at 30-day was 78.3% (18/23). In patients successfully weaned from RVAD support, survival to discharge and 30-day survival were 90%. CONCLUSIONS: Concomitant RVAD placement appears to be a helpful treatment strategy for intraoperative RVF. Patients who are successfully weaned from RVAD support have acceptable short-term outcomes following discontinuation of support, although further research is needed.