title: Relation of preoperative serum albumin levels to survival in patients undergoing left ventricular assist device implantation.
abstract: Hypoalbuminemia has been recognized as a prognostic indicator in patients with heart failure. We aimed to investigate the association of hypoalbuminemia with postoperative mortality in patients undergoing left ventricular assist device (LVAD) implantation. We studied 272 consecutive patients undergoing LVAD implantation from 2000 to 2010 at our institution. Preoperative clinical characteristics and laboratory variables associated with mortality were analyzed. Postoperative survival of patients with preoperative hypoalbuminemia (<3.5 g/dl, n = 125) and those with normal albumin concentration (≥3.5 g/dl, n = 147) was compared. Survival after LVAD surgery was better in patients with normal albumin levels compared with those with hypoalbuminemia before surgery (3 and 12 months: 93.2% vs 82.4% and 88.4% vs 75.2%, respectively, p <0.001). Multivariate analysis revealed that preoperative albumin was independently associated with mortality after LVAD implantation (hazard ratio 0.521, 95% confidence interval 0.290 to 0.934; p = 0.029.) Furthermore, the impact of normalization of albumin levels during LVAD support on postoperative survival was analyzed in both groups. Subgroup analysis of patients with preoperative hypoalbuminemia and postoperative normalization of albumin levels (n = 81) showed improved survival compared with those who remained hypoalbuminemia (n = 44) or those who had decreasing albumin levels during LVAD support (n = 40; 3-month survival: 92.6% vs 63.6% and 65.0%; p <0.01). In conclusion, preoperative hypoalbuminemia is associated with poor prognosis after LVAD surgery. Postoperative normalization of albumin level is associated with improved survival. Attention to albumin levels by correcting nutrition, inflammation, and hepatic function could be an effective way to improve prognosis in patients evaluated for LVAD implantation.
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York. Electronic address: rinnko@sannet.ne.jp.
authors.forename: Tomoko S
authors.initials: TS
authors.lastname: Kato
authors.forename: Shuichi
authors.initials: S
authors.lastname: Kitada
authors.forename: Jonathan
authors.initials: J
authors.lastname: Yang
authors.forename: Christina
authors.initials: C
authors.lastname: Wu
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.forename: Maryjane
authors.initials: M
authors.lastname: Farr
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
authors.forename: P Christian
authors.initials: PC
authors.lastname: Schulze
mesh_terms: D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000401:mortality / Q000601:surgery; D006353:Heart-Assist Devices; D006801:Humans; D009518:New York / Q000453:epidemiology; D011184:Postoperative Period; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D012709:Serum Albumin
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