title: Risk factor analysis of Swedish Left Ventricular Assist Device (LVAD) patients.
abstract: BACKGROUND
  The use of left ventricular assist devices (LVADs) is established as a bridge to heart transplantation.
  
  
  METHODS
  All Swedish patients on the waiting list for heart transplantation, treated with LVAD since 1993 were retrospectively collected into a database and analyzed in regards to risk factors for mortality and morbidity.
  
  
  RESULTS
  Fifty-nine patients (46 men) with a median age of 49 years (range, 14 to 69 years), Higgins score median of 9 (range, 3 to 15), EuroScore median of 10 (range, 5 to 17) were investigated. Dominating diagnoses were dilated cardiomyopathy in 61% (n = 36) and ischemic cardiomyopathy in 18.6% (n = 11). The patients were supported with LVAD for a median time of 99.5 days (range, 1 to 873 days). Forty-five (76%) patients received transplants, and 3 (5.1%) patients were weaned from the device. Eleven patients (18.6%) died during LVAD treatment. Risk factor analysis for mortality before heart transplantation showed significance for a high total amount of autologous blood transfusions (p < 0.001), days on mechanical ventilation postoperatively (p < 0.001), prolonged postoperative intensive care unit stay (p = 0.007), and high central venous pressure 24 hours postoperatively and at the final measurement (p = 0.03 and 0.01, respectively). Mortality with LVAD treatment was 18.6% (n = 11). High C-reactive protein (p = 0.001), low mean arterial pressure (p = 0.03), and high cardiac index (p = 0.03) preoperatively were risk factors for development of right ventricular failure during LVAD treatment.
  
  
  CONCLUSIONS
  The Swedish experience with LVAD as a bridge to heart transplantation was retrospectively collected into a database. This included data from transplant and nontransplant centers. Figures of mortality and morbidity in the database were comparable to international experience. Specific risk factors were difficult to define retrospectively as a result of different protocols for follow-up among participating centers.
authors.affiliation: Department of Cardiovascular Surgery and Anesthesia, University Hospital, Linköping, Sweden. hans.granfeldt@lio.se
authors.forename: Hans
authors.initials: H
authors.lastname: Granfeldt
authors.forename: Bansi
authors.initials: B
authors.lastname: Koul
authors.forename: Lars
authors.initials: L
authors.lastname: Wiklund
authors.forename: Bengt
authors.initials: B
authors.lastname: Peterzén
authors.forename: Urban
authors.initials: U
authors.lastname: Lönn
authors.forename: Ankica
authors.initials: A
authors.lastname: Babic
authors.forename: Henrik C
authors.initials: HC
authors.lastname: Ahn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000401:mortality / Q000601:surgery; D005260:Female; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014850:Waiting Lists