title: Preoperative risk factors for mortality after biventricular assist device implantation.
abstract: BACKGROUND
  A right ventricular assist device is a treatment option for patients with severe right ventricular failure after left ventricular assist device (LVAD) implantation. Recognition of risk factors for mortality after biventricular assist device (BiVAD) implantation is important for patient selection and optimal outcomes.
  
  
  METHODS
  We reviewed our experiences between 1991 and 2005 in 44 patients who were supported by both an LVAD and a right ventricular assist device.
  
  
  RESULTS
  Thirteen patients (30%) survived until heart transplantation, and 31 patients (70%) died while on support. The multivariate analysis shows that post-LVAD extracorporeal membrane oxygenation and worsening renal function are associated with the highest postoperative mortality. The univariate analysis also included previous thoracic surgery and ischemic cardiomyopathy as potential preoperative indicators for poor outcome after BiVAD implants. No differences were observed in the rates for the need of preoperative support with a ventilator, an intra-aortic balloon pump, or extracorporeal membrane oxygenation, or in the rates of postoperative complications between survivors and nonsurvivors.
  
  
  CONCLUSIONS
  BiVAD implantation remains one of the challenges in treating severe heart failure. Previous cardiac surgery, elevated creatinine, and post-LVAD extracorporeal membrane oxygenation were risk factors for mortality after BiVAD implantation. Dialated Cardiomyopathy on the other hand was associated with a more favorable outcome.
authors.affiliation: Department of Cardiovascular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Firas
authors.initials: F
authors.lastname: Zahr
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Ootaki
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Smedira
authors.forename: Mohamad
authors.initials: M
authors.lastname: Yamani
authors.forename: Lucy
authors.initials: L
authors.lastname: Thuita
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Fukamachi
mesh_terms: D000328:Adult; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D006353:Heart-Assist Devices / Q000009:adverse effects / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000009:adverse effects / Q000639:trends*; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000639:trends*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018497:Ventricular Dysfunction, Right / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*