title: Lower body surface area is highly related to mortality due to stroke or systemic bleeding in patients receiving an axial flow blood pump as a left ventricular assist device.
abstract: OBJECTIVE
  Even though left ventricular assist devices (LVADs) may fit into the bodies of small adult patients, their prognosis is worse than that of larger patients. We investigated the relationship between lethal complications and the body surface area (BSA) in patients who received an LVAD.
  
  
  METHODS
  Our study included 167 patients who received a BerlinHeart INCOR LVAD in our centre. The median BSA was 2.00 m(2) (range: 1.56-2.47 m²). From the line graph showing the relationship between the BSA for the cut-off point and the P-value of the log-rank test for the Kaplan-Meier probability of freedom from events, the definitive cut-off point was determined on the basis that, with a decrease in the BSA below this value, the P-value gradually increases.
  
  
  RESULTS
  For freedom from death due to stroke or systemic bleeding, a definitive cut-off point existed and this was a BSA of 1.867 m(2). For freedom from death due to sepsis, no definitive cut-off point was found. The multivariate Cox analysis revealed that a BSA of <1.867 m(2) was an independent risk factor for death due to stroke or systemic bleeding (hazard ratio: 2.665, 95% confidence interval: 1.349-5.265, P = 0.0048). One-year freedom from death due to stroke or systemic bleeding during the VAD support was 49.1% in patients with a BSA of <1.867 m(2) (n = 42) and 82.7% in those with a BSA of ≥ 1.867 m(2) (n = 125; P = 0.0033).
  
  
  CONCLUSIONS
  The lower BSA is an independent risk factor for mortality due to stroke or systemic bleeding during the VAD support.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany. komoda@dhzb.de
authors.forename: Takeshi
authors.initials: T
authors.lastname: Komoda
authors.forename: Thorsten
authors.initials: T
authors.lastname: Drews
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
authors.forename: Hans B
authors.initials: HB
authors.lastname: Lehmkuhl
mesh_terms: D000368:Aged; D001830:Body Surface Area; D006348:Cardiac Surgical Procedures / Q000295:instrumentation*; D005260:Female; D006333:Heart Failure / Q000601:surgery; D006353:Heart-Assist Devices; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D019919:Prosthesis Implantation / Q000295:instrumentation*; D012044:Regression Analysis; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*