title: Safety of parenteral nutrition in patients receiving a ventricular assist device.
abstract: Patients with advanced heart failure and poor nutritional status are predisposed to higher rates of infection, bleeding, and mortality. We have increasingly used perioperative parenteral nutrition (PN) in ventricular assist device (VAD) patients and now report our initial experience. We performed a retrospective review of 43 consecutive patients who received implantable VADs from 2006 to 2009. We compared outcomes for patients receiving PN for >7 days perioperatively vs ≤7 days. In addition, we compared patients who received preoperative enteral nutrition (EN) with those who did not. Fourteen patients received perioperative PN in addition to EN for >7 days compared with 29 patients who received either PN for ≤7 days or EN alone. Univariate analysis showed no differences in infection, bleeding, thrombus, stroke, length of stay, or mortality. Multivariate stepwise regression including EN, preoperative PN, Interagency Registry for Mechanically Assisted Circulation score, age, gender, and VAD indication showed that only EN was associated with infection. Prolonged use of perioperative PN appears to be safe and well tolerated in patients undergoing VAD implantation. Preoperative EN, while increasing infection risk, seems to have no harmful effect on survival.
authors.affiliation: From the *Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, New York; †Department of Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; ‡Department of Medicine, Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York; §Department of Medicine, Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York; and ¶Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Corey
authors.initials: C
authors.lastname: Scurlock
authors.forename: Sean P
authors.initials: SP
authors.lastname: Pinney
authors.forename: Hung-Mo
authors.initials: HM
authors.lastname: Lin
authors.forename: Matthew
authors.initials: M
authors.lastname: Potenza
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Weiss
authors.forename: Neeha
authors.initials: N
authors.lastname: Zaidi
authors.forename: Anelechi
authors.initials: A
authors.lastname: Anyanwu
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Mechanick
mesh_terms: D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D012189:Retrospective Studies