Impact of abdominal complications on outcome after mechanical circulatory support.
BACKGROUND
Mechanical circulatory support (MCS) is life sustaining for patients with end-stage heart failure. Most devices require abdominal wall transgression, creating a potential for abdominal complications. The incidence and impact of these relatively underreported complications are unknown.


METHODS
A retrospective review was performed on 179 patients who received MCS therapy from 1999 to 2008. Abdominal complications were grouped as abdominal wall, gastrointestinal tract, and solid organ.


RESULTS
Ninety-eight patients (55%) experienced 157 abdominal complications. These involved the abdominal wall in 69 (44%), the gastrointestinal tract in 52 (33%), and the solid organs in 36 (23%). Surgical intervention was required in 36% of patients with abdominal wall complications, 19% of patients with gastrointestinal tract complications, and 14% of patients with solid organ complications. Multivariate analysis identified diabetes mellitus (p < 0.001), emergent device placement (p = 0.019), and preimplant mechanical ventilation (p = 0.045) as independent risk factors for developing an abdominal complication. Kaplan-Meier survival while receiving MCS was significantly reduced for patients with abdominal complications versus those without (p = 0.0142). Multivariate analysis identified only solid organ abdominal complications (p = 0.001) as an independent risk factor for death while receiving device support.


CONCLUSIONS
Abdominal complications are common in patients supported with MCS devices and significantly reduce survival. Surgical intervention is more frequently required for complications related to the abdominal wall compared with other complications. Patients with significant comorbidities (diabetes mellitus, respiratory failure) requiring urgent or emergent device placement are at higher risk for the development of abdominal complications with an attendant reduction in device-related survival.
Bhama
Jay K
JK
Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA. bhamajk@upmc.edu
Rayappa
Steven
S
Zaldonis
Diana
D
Adusumilli
Prasad S
PS
Bansal
Aditya
A
Genovese
Elizabeth A
EA
Teuteberg
Jeffrey J
JJ
Toyoda
Yoshiya
Y
Siegenthaler
Michael P
MP
Bermudez
Christian A
CA
McCurry
Kenneth R
KR
Kormos
Robert L
RL
D000007:Abdominal Injuries / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D034861:Abdominal Wall / Q000601:surgery; D000328:Adult; D000368:Aged; D004066:Digestive System Diseases / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000401:mortality / Q000601:surgery; D012086:Reoperation / Q000401:mortality; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology / Q000401:mortality / Q000601:surgery; D016019:Survival Analysis; D014781:Viscera / Q000293:injuries / Q000601:surgery