Screening scale predicts patients successfully receiving long-term implantable left ventricular assist devices.
BACKGROUND
Although use of long-term implantable left ventricular assist devices (LVAD) is becoming more popular, further reduction of the mortality rate accompanying device insertion through improved patient selection would make this alternative even more appealing. We sought to develop a scoring system that was based on criteria obtainable at the time of evaluation and predictive of successful early outcome and simple to apply.


RESULTS
Patients (n = 56) undergoing LVAD insertion between 1990 and 1994 were screened for easily obtainable preoperative risk factors. To test the association between survival and each risk factor, a chi 2 analysis was performed, and relative risks were estimated. Oliguria, ventilator dependence, elevated central venous pressure, elevated prothrombin time, and reoperation stats had low probability values and high estimated relative risks. On the basis of these relations, a risk factor-selection scale (RFSS) (range, 0 to 10) was developed by computing appropriate weights for each risk factor. The distribution of patients for each scale score reveal that with RFSS > or = 5, most device recipients will die (P < .001). The average RFSS (+/- SD) of survivors (n = 42) was 2.45 +/- 1.73 compared with 5.43 +/- 2.85 in nonsurvivors (n = 14) (P < .0001). Univariate logistical regression was also significant (score statistic, 16.2; df = 1; P = .001).


CONCLUSIONS
The RFSS is simple, easy to apply, and statistically valid. Physicians could use the scale as a starting point in discussing the suitability for LVAD implantation in a specific patient and as a basis for comparing patient outcomes.
Oz
M C
MC
Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Goldstein
D J
DJ
Pepino
P
P
Weinberg
A D
AD
Thompson
S M
SM
Catanese
K A
KA
Vargo
R L
RL
McCarthy
P M
PM
Rose
E A
EA
Levin
H R
HR
D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006331:Heart Diseases / Q000145:classification*; D006353:Heart-Assist Devices; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D019736:Prostheses and Implants; D012307:Risk Factors; D016019:Survival Analysis; D016277:Ventricular Function, Left