title: Outcomes and predictors of early mortality after continuous-flow left ventricular assist device implantation as a bridge to transplantation.
abstract: Left ventricular assist devices (LVADs) are fast becoming standard of care for patients with advanced heart failure. However, despite continuous improvement in VAD technology, there remains a significant early postoperative morbidity and mortality in this extreme patient group. The aim of the current study was to explore the short-term outcomes and predictors for 90 day mortality in the patients after implantation of continuous-flow LVAD. Perioperative clinical, echocardiographic, hemodynamic, and laboratory data of 90 day survivors and nonsurvivors were collected and compared retrospectively. Multivariate logistic regression analysis was performed on univariate predictors for 90 day mortality with an entry criterion of p < 0.1. Between July 2006 and May 2012, 117 patients underwent implantation of a continuous-flow LVAD as a bridge to transplantation: 71 (60.7%) HeartMate II (Thoratec Corp, Pleasanton, CA) and 46 (39.3%) HVAD (HeartWare International, Framingham, MA). All-cause 90 day mortality was 17.1%. Multivariate analysis revealed higher preoperative central venous pressure (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.014-1.378; p = 0.033) and higher age (OR, 1.14; 95% CI, 1.01-1.38; p = 0.045) as the only independent predictors for 90 day mortality. Optimization of preoperative volume status, preload, and right heart function as well as age-based selection of candidates for LVAD support are the critical factors influencing early outcome after continuous-flow LVAD implantation.
authors.affiliation: From the *Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom; †Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany; and ‡Department of Heart Failure and Transplant Medicine, Royal Brompton & Harefield NHS Foundation Trust, Hill End Road, Harefield, Middlesex, United Kingdom.
authors.forename: Anton
authors.initials: A
authors.lastname: Sabashnikov
authors.forename: Prashant N
authors.initials: PN
authors.lastname: Mohite
authors.forename: Bartlomiej
authors.initials: B
authors.lastname: Zych
authors.forename: Diana
authors.initials: D
authors.lastname: García
authors.forename: Aron-Frederik
authors.initials: AF
authors.lastname: Popov
authors.forename: Alexander
authors.initials: A
authors.lastname: Weymann
authors.forename: Nikhil P
authors.initials: NP
authors.lastname: Patil
authors.forename: Rachel
authors.initials: R
authors.lastname: Hards
authors.forename: Massimo
authors.initials: M
authors.lastname: Capoccia
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wahlers
authors.forename: Fabio
authors.initials: F
authors.lastname: De Robertis
authors.forename: Toufan
authors.initials: T
authors.lastname: Bahrami
authors.forename: Mohamed
authors.initials: M
authors.lastname: Amrani
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Banner
authors.forename: André R
authors.initials: AR
authors.lastname: Simon
mesh_terms: D000328:Adult; D013504:Cardiovascular Surgical Procedures / Q000401:mortality*; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D016896:Treatment Outcome