Short and long term outcomes of 200 patients supported by continuous-flow left ventricular assist devices

doi:10.4330/wjc.v7.i11.792

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Nov 26, 2015 (publication date) through Jul 31, 2024

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World Journal of Cardiology

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Retrospective Study

World J Cardiol. Nov 26, 2015; 7(11): 792-800
Published online Nov 26, 2015. doi: 10.4330/wjc.v7.i11.792

Table 1 Patient demographics and comorbidities

Variable	Total (n = 200)	BTT (n = 98)	DT (n = 102)	P value
Age (yr)	54.3 ± 12.5	50.1 ± 12.8	58.4 ± 10.7	0.001
Gender
Female	24% (48/200)	25.5% (25/98)	22.8% (23/102)
Male	76% (151/200)	74.5% (73/98)	76.5% (78/102)	0.652
Race
AA	46% (92/200)	39.8% (39/98)	52% (53/102)	0.375
Caucasian	54% (108/200)	54.1% (53/98)	42.4% (47/102)
Etiology of heart failure
ICM	52% (104/200)	29% (28/98)	74.5% (76/102)	0.001
NIDCM	48% (96/200)	51% (50/98)	45.1% (46/102)
BSA	1.97 ± 0.27	1.96 ± 0.27	1.98 ± 0.28	0.667
BMI	28.3 ± 5.5	28.1 ± 4.3	28.5 ± 6.5	0.763
Albumin (g/dL)	4.14 ± 10.03	3.19 ± 0.51	5.06 ± 14.05	0.015
DM	46% (92/200)	38.8% (38/98)	52.9% (54/102)	0.038
HTN	83% (166/200)	79.6% (78/98)	86.2% (88/102)	0.153
CRI	40% (81/200)	29.6% (29/98)	51% (52/102)	0.002
Dialysis	2.5% (5/200)	3.1% (3/98)	1.8% (2/102)	0.680
COPD	15.5% (31/200)	15.3% (15/98)	15.7% (16/102)	0.917
PVD	12% (23/200)	7.1% (7/98)	15.7% (16/102)	0.055
Vented	12% (25/200)	9.2% (9/98)	15.7% (16/102)	0.134
Previous cardiac surgery	32% (63/200)	20.4% (20/98)	42% (43/102)	0.001
Creatinine (mg/dL)	1.42 ± 0.62	1.43 ± 0.58	1.42 ± 0.65	0.869
AST (U/L)	48.3 ± 82.8	58.0 ± 106.8	38.9 ± 45.7	0.212
ALT (U/L)	46.5 ± 78.5	59.8 ± 99.4	33.5 ± 47.3	0.002
CPB time (min)	113.5 ± 46.1	109.5 ± 46.0	117.8 ± 46.1	0.178
XCL time (min)	71 ± 30.6	85.2 ± 33.7	51.7 ± 26.0	0.054
MCS at time of VAD	18% (36/200)	24% (23/98)	13% (13/102)	0.051
On inotropes at time of VAD	75%(150/200)	81% (80/98)	69% (70/102)	0.036
Pre VAD CVP (mmHg)	11.8 ± 6.4	11.6 ± 6.4	12.0 ± 6.4	0.653
Pre VAD PAPs (mmHg)	51.4 ± 14.2	50.5 ± 14.5	52.3 ± 13.8	0.412
Pre VAD PAPd (mmHg)	24.5 ± 9.2	24.4 ± 9.8	24.7 ± 8.5	0.682
Pre Vad CI (L/min per square metre)	1.85 ± 0.51	1.87 ± 0.54	1.83 ± 0.47	0.961
Pre VAD PCWP (mmHg)	23.0 ± 9.6	22.7 ± 9.8	23.4 ± 9.4	0.463
Blood transfusions	23% (46/200)	18% (18/98)	27% (28/102)	0.250
Concomitant cardiac procedure	19% (39/200)	23% (23/98)	15% (16/102)	0.137

BTT: Bridge to transplant; DT: Destination therapy; ICM: Ischemic cardiomyopathy; NIDCM: Non ischemic dilated cardiomyopathy; BSA: Body surface area; BMI: Body mass index; DM: Diabetes mellitus; HTN: Hypertension; CRI: Chronic renal insufficiency; COPD: Chronic obstructive pulmonary disease; PVD: Peripheral vascular disease; AST: Aspartate transaminase; ALT: Alanine aminotransferase; CPB: Cardiopulmonary bypass; XCl: Cross clamp; MCS: Mechanical circulatory support; VAD: Ventricular assist device; CVP: Central venous pressure; PAP: Pulmonary artery systolic pressure; PAPd: Pulmonary artery diastolic pressure; CI: Cardiac index; PCWP: Pulmonary capillary wedge pressure.

Table 2 Postoperative outcomes

Variable	Total (n = 200)	BTT (n = 98)	DT (n = 102)	P value
Postoperative ICU stay (d)	195 10.7 ± 10.4	95 10.2 ± 7.7	100 11.2 ± 12.5	0.833
Overall length of stay (d)	198 21.4 ± 14.3	98 20.8 ± 12.9	100 22.1 ± 15.6	0.517
Readmitted within 30 d	26.5% (53/200)	26.0 (25/96)	27% (28/102)	0.725
Reexploration for bleeding	15% (31/200)	10% (10/98)	5% (6/102)	0.040
DL infection	7% (15/200)	9% (9/98)	5% (6/102)	0.386
Pocket infection	1% (2/200)	1% (1/98)	1% (1/102)	0.493
Pneumonia	7% (15/200)	9% (9/98)	5% (6/102)	0.375
Hemorrhagic stroke	10% (21/200)	9% (9/98)	11% (12/102)	0.432
Emboli stroke	5% (10/200)	6% (6/98)	3% (4/102)	0.493
VDRF	9% (19/200)	10% (10/98)	8% (9/102)	0.774
Tracheostomy	2% (5/200)	1% (1/98)	3% (4/102)	0.369
Dialysis	2% (5/200)	3% (3/98)	1% (2/102)	0.680
GIB	21% (43/200)	17% (17/98)	25% (26/102)	0.289
Reoperation for Al	2% (4/200)	4% (4/98)	0% (0/102)	0.058
RV failure	19% (38/200)	15% (15/98)	22% (23/102)	0.192
RV failure requiring milrinone	13% (26/200)	9% (9/98)	16% (17/102)	0.103
RV failure requiring RVAD	6% (12/200)	6% (6/98)	5% (6/102)	0.803
Heart transplant	27% (55/200)	45% (45/98)	10% (10/102)	0.001
Duration of support (d)	581.0 ± 517.9	554.8 ± 535.0	606.4 ± 502.1	0.253

ICU: Intensive care unit; DL: Driveline; VDRF: Ventilator dependent respiratory failure; GIB: Gastrointestinal bleeding; AI: Aortic insufficiency; RV: Right ventricular; RVAD: Right ventricular assist device.

Table 3 Outcomes for bridge to transplan and destination therapy patients

	Variable	Patients (%)
BTT	Died	28.6 (28/98)
	Ongoing	25.5 (25/98)
	Transplant	45.9 (45/98)
DT	Died	34.3 (35/102)
	Ongoing	54.8 (56/102)
	Transplant	9.8 (10/102)

Table 4 Hemodymanic measurements pre and post left ventricular assist device at 6 mo

Variables	Pre VAD	Post VAD	P value
CVP (mmHg)	12 ± 6	8 ± 4.5	0.001
PAPs (mmHg)	53.52 ± 13.76	36.03 ± 11.85	0.001
PAPd (mmHg)	26.15 ± 9.50	16.11 ± 6.24	0.001
CI (L/min per square meter)	1.78 ± 0.39	2.52 ± 0.60	0.001
PCWP (mmHg)	25.09 ± 10.05	11.93 ± 7.84	0.001
LVEDD (mm)	71.70 ± 13.61	57.45 ± 15.3	0.001
LVEF (%)	16 ± 7.90	21 ± 9.00	0.017

VAD: Ventricular assist device; CVP: Central venous pressure; PAP: Pulmonary artery systolic pressure; PAPd: Pulmonary artery diastolic pressure; CI: Cardiac index; PCWP: Pulmonary capillary wedge pressure; LVEDD: Left ventricular end diastolic diameter; LVEF: Left ventricular ejection fraction.

Table 5 Multiple cox proportional hazard models

Variable	HR 95%CI	P value	Backwards stepwise model
Albumin	0.64 (0.27, 1.52)	0.310
Length of stay	0.85 (0.62, 1.17)	0.319
CPB time	1.05 (0.98, 1.14)	0.175
CRI	1.13 (0.44, 2.91)	0.804
PVD	0.95 (0.30, 3.03)	0.931
Vented	0.93 (0.17, 4.97)	0.929
Creatinine	0.77 (0.37, 1.63)	0.495
PreVAD AST	1.03 (1.00, 1.07)	0.072	1.03 (1.01, 1.05) 0.01
PreVAD ALT	1.02 (1.00, 1.05)	0.064	1.02 (1.01, 1.04) 0.02
Blood transfusion	1.19 (0.45, 3.14)	0.732
ICU stay	0.80 (0.52, 1.24)	0.320
Reexploration	1.70 (0.50, 5.79)	0.794
VDRF	4.92 (1.62, 14.93)	0.005	3.05 (1.41, 6.59) 0.005
Tracheostomy	5.53 (0.65, 46.78)	0.116	4.54 (1.35, 15.32) 0.015
RV failure	0.45 (0.09, 2.26)	0.330
RVAD	8.90 (1.30, 61.06)	0.066	3.64 (1.59, 8.36) 0.002
Age	1.02 (0.95, 1.12 )	0.176
Gender	0.75 (0.66, 1.56 )	0.321
Resternotomy	1.31 (0.83, 4.55)	0.673
Etiology of heart failure	1.23 (0.59, 4.08)	0.512

CPB: Cardiopulmonary bypass; CRI: Chronic renal insufficiency; PVD: Peripheral vascular disease; AST: Aspartate transaminase; ALT: Alanine aminotransferase; ICU: Intensive care unit; VDRF: Ventilator dependent respiratory failure; RV: Right ventricular; RVAD: Right ventricular assist device.

Citation: Tsiouris A, Paone G, Nemeh HW, Borgi J, Williams CT, Lanfear DE, Morgan JA. Short and long term outcomes of 200 patients supported by continuous-flow left ventricular assist devices. World J Cardiol 2015; 7(11): 792-800
URL: https://www.wjgnet.com/1949-8462/full/v7/i11/792.htm
DOI: https://dx.doi.org/10.4330/wjc.v7.i11.792