title: Predictor of early mortality for severe heart failure patients with left ventricular assist device implantation: significance of INTERMACS level and renal function.
abstract: BACKGROUND
  The preoperative risk factors for left ventricular assist device (LVAD) implantation and their impact on the clinical outcome was analyzed to evaluate the optimal timing of LVAD implantation for severe heart failure patients.
  
  
  RESULTS
  From January 2006 to August 2011, 82 patients underwent 84 LVAD implantations at the Osaka University Hospital. These patients were categorized into 2 groups: Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level 1 (n=41) and INTERMACS level 2/3 (n=43). The preoperative characteristics, early mortality, and cumulative survival between the 2 groups was compared. Ten (24.4%) patients died within 90 days in the INTERMACS level 1 group (multiple organ failure: 6, cerebrovascular event: 3, sepsis: 1), whereas 1 (2.3%) patient died because of a cerebrovascular event in the INTERMACS level 2/3 group (P=0.003). The cumulative survival rate was 82.9% at 30 days, 75.6% at 90 days, and 63.7% after 1 year in the INTERMACS level 1 group, and 100%, 97.7%, and 85.3% in the level 2/3 group (P=0.015). Using multivariate analysis for the INTERMACS level 1 group data, the preoperative serum creatinine level was the independent predictor of 90-day mortality.
  
  
  CONCLUSIONS
  LVAD implantation in a stable condition contributes to better clinical outcome for severe heart failure patients. If critical cardiogenic shock occurs, LVAD implantation must be considered immediately before other organs' functions, especially renal function, deteriorate.
authors.affiliation: Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yoshioka
authors.forename: Taichi
authors.initials: T
authors.lastname: Sakaguchi
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Saito
authors.forename: Shigeru
authors.initials: S
authors.lastname: Miyagawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nishi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yoshikawa
authors.forename: Satsuki
authors.initials: S
authors.lastname: Fukushima
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Saito
authors.forename: Takashi
authors.initials: T
authors.lastname: Daimon
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ueno
authors.forename: Toru
authors.initials: T
authors.lastname: Kuratani
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sawa
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000378:metabolism / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D003404:Creatinine