Early adverse events as predictors of 1-year mortality during mechanical circulatory support.
BACKGROUND
Ventricular assist devices (VADs) provide effective treatment for end-stage heart failure; however, most patients experience > or =1 major adverse events (AEs) while on VAD support. Although early, non-fatal AEs may increase the risk of later death during VAD support, this relationship has not been established. Therefore, we sought to determine the impact on 1-year mortality of AEs occurring during the first 60 days of VAD support.


METHODS
A retrospective analysis was performed using prospectively collected data from a single-site database for patients aged > or =18 years receiving left ventricular or biventricular support during 1996 to 2008 and who survived >60 days on VAD support. Fourteen major classes of AEs occurring during this 60-day period were examined. One-year survival rates of patients with and without each major AE were compared.


RESULTS
The study included 163 patients (80% men; mean age, 49.5 years), of whom 87% were European American, 72% had left ventricular support, and 83% were bridge to transplant. The occurrence of renal failure, respiratory failure, bleeding events, and reoperations during the first 60 days after implantation significantly increased the risk of 1-year mortality. After controlling for gender, age, VAD type, and intention to treat, renal failure was the only major AE significantly associated with later mortality (hazard ratio, 2.96; p = .023).


CONCLUSIONS
Specific AEs, including renal failure, respiratory and bleeding events, and reoperations, significantly decrease longer-term survival. Renal failure conferred a 3-fold increased risk of 1-year mortality. Peri-operative management should focus on strategies to mitigate risk for renal failure in order to maximize later outcomes.
Genovese
Elizabeth A
EA
Artificial Heart Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Dew
Mary Amanda
MA
Teuteberg
Jeffrey J
JJ
Simon
Marc A
MA
Bhama
Jay K
JK
Bermudez
Christian A
CA
Lockard
Kathleen L
KL
Winowich
Steve
S
Kormos
Robert L
RL
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004867:Equipment Design; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality / Q000706:statistics & numerical data; D006353:Heart-Assist Devices / Q000009:adverse effects; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007239:Infections / Q000209:etiology; D007674:Kidney Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012140:Respiratory Tract Diseases / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult