title: Periportal fibrosis without cirrhosis does not affect outcomes after continuous flow ventricular assist device implantation.
abstract: OBJECTIVE
  This study investigates the relationship of periportal fibrosis on postoperative outcomes after ventricular assist device (VAD) implantation.
  
  
  METHODS
  Between July 2005 and August 2014, a total of 233 patients were implanted with continuous flow VADs. Liver biopsy was performed on 16 patients with concern for liver disease. Survival was evaluated using the Kaplan-Meier method. The effect of fibrosis on length of stay (LOS) in the intensive care unit was modeled using Poisson regression. Adjustments were made for age, profile from the Interagency Registry for Mechanically Assisted Circulatory Support, biopsy, and model for end-stage liver disease score.
  
  
  RESULTS
  Fourteen of the 16 patients who underwent biopsy had periportal fibrosis without cirrhosis. One-year survival for the groups with and without biopsy-proven fibrosis was 93% ± 7% and 86% ± 2% (P = .97), respectively. The intensive care unit LOS was not different for those with (median, 7 days; interquartile range: 3-14 days) versus without fibrosis (median, 6 days; interquartile range 4-10 days; P = .65). Fibrosis (P = .42), age (0.95), model for end-stage liver disease excluding internal normalized ratio-XI score (P = .64), performance of a biopsy (P = .28), and Interagency Registry for Mechanically Assisted Circulatory Support class (P = .70) were not associated with intensive care unit LOS. Risk was increased of gastrointestinal bleeding (14% vs 4%; P = .026) in the first year among patients with fibrosis.
  
  
  CONCLUSIONS
  The presence of periportal fibrosis did not affect survival or outcomes in patients undergoing VAD implantation. These findings suggest that carefully selected patients with advanced heart failure and hepatic fibrosis without cirrhosis may achieve acceptable outcomes with VAD implantation.
authors.affiliation: School of Medicine, University of Washington, Seattle, Wash.
authors.forename: Jonathon E
authors.initials: JE
authors.lastname: Sargent
authors.affiliation: Division of Cardiology, University of Washington, Seattle, Wash.
authors.forename: Todd F
authors.initials: TF
authors.lastname: Dardas
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington, Seattle, Wash.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Smith
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington, Seattle, Wash.
authors.forename: Jay D
authors.initials: JD
authors.lastname: Pal
authors.affiliation: Division of Cardiology, University of Washington, Seattle, Wash.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Cheng
authors.affiliation: Division of Cardiology, University of Washington, Seattle, Wash.
authors.forename: S Carolina
authors.initials: SC
authors.lastname: Masri
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington, Seattle, Wash.
authors.forename: Kent R
authors.initials: KR
authors.lastname: Shively
authors.affiliation: School of Medicine, University of Washington, Seattle, Wash.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Colyer
authors.affiliation: Division of Cardiology, University of Washington, Seattle, Wash.
authors.forename: Claudius
authors.initials: C
authors.lastname: Mahr
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington, Seattle, Wash. Electronic address: mokadamn@uw.edu.
authors.forename: Nahush A
authors.initials: NA
authors.lastname: Mokadam
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D016276:Ventricular Function
keywords: heart failure; heart-assist devices; liver diseases; survival analysis