title: Does elective or emergent operative status influence outcomes in patients undergoing implantation of left ventricular assist devices?
abstract: BACKGROUND
  Acuity models to predict survival after left ventricular assist device (LVAD) implantation do not include operative status as one of the calculated variables. The effect of elective versus emergent LVAD implantation on outcomes has not been examined.
  
  
  METHODS
  Patients were stratified into 2 groups based on operative status (elective versus emergent). Variables were compared to determine whether there were differences in outcomes between elective versus emergent LVAD recipients
  
  
  RESULTS
  Of the 130 patients, 59 underwent an elective procedure, whereas 71 had their LVAD implanted as an urgent/emergent operation. Patients in the urgent/emergent cohort had significantly worse preoperative hepatic and renal function and higher central venous pressures. Survival rates at 30 days, 6 months, 1 year, and 2 years were analogous for both cohorts. Patients in the emergent cohort had a higher incidence of postoperative right ventricular failure, with the requirement for short-term right ventricular support in 9.9% versus 1.7% (P = 0.054). The incidence of other LVAD-related complications, were similar in both groups. Emergency status did not predict postoperative mortality in univariate analysis.
  
  
  CONCLUSIONS
  Although patients who underwent emergent LVAD implantations had worse preoperative renal and liver function and a higher incidence of postoperative right ventricular failure, they exhibited similar midterm survival and a similar incidence of other postoperative complications.
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, MI, USA.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Tsiouris
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, MI, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Morgan
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, MI, USA.
authors.forename: Hassan W
authors.initials: HW
authors.lastname: Nemeh
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, MI, USA.
authors.forename: Arielle
authors.initials: A
authors.lastname: Hodari
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, MI, USA.
authors.forename: Rupen
authors.initials: R
authors.lastname: Shah
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, MI, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Brewer
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, MI, USA.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paone
mesh_terms: D017677:Age Distribution; D015897:Comorbidity; D017558:Elective Surgical Procedures / Q000401:mortality*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D006353:Heart-Assist Devices / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D019919:Prosthesis Implantation / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000401:mortality* / Q000517:prevention & control