Philipp Angleitner1, Paul Simon2, Alexandra Kaider3, Dominik Wiedemann2, Kamen Dimitrov2, Thomas Schlöglhofer4, Maria Angela Rajek5, Julia Riebandt2, Günther Laufer2, Daniel Zimpfer2. 1. Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria. Electronic address: philipp.angleitner@meduniwien.ac.at. 2. Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria. 3. Center for Medical Statistics, Informatics, and Intelligent Systems (CEMSIIS), Medical University of Vienna, Vienna, Austria. 4. Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria. 5. Division of Cardiac Thoracic Vascular Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria.
Abstract
BACKGROUND: Few reports have described associations between a bleeding revision and outcomes after implantation of a continuous-flow left ventricular assist device (LVAD). METHODS: We retrospectively analyzed all adult recipients of a continuous-flow LVAD who were operated on between January 2006 and December 2016 at the Division of Cardiac Surgery, Medical University of Vienna (N = 257). LVAD types were HeartWare HVAD (Medtronic, Minneapolis, MN), HeartMate II (Abbott [Thoratec], Abbott Park, IL), and HeartMate 3 (Abbott [Thoratec]). The primary outcome variable was survival during LVAD support. Secondary outcome variables were rates of prolonged ventilation, intensive care unit stay, hospital stay, renal replacement therapy, and stroke. We additionally investigated risk factors for a bleeding revision. RESULTS: Thirty-six patients (14%) underwent surgical revision for bleeding. In a multivariable Cox proportional hazards model, bleeding revision was associated with significantly reduced survival during LVAD support (3 months: hazard ratio [HR], 2.04; 95% confidence interval [CI], 1.20 to 3.48; 6 months: HR, 1.63; 95% CI, 0.95 to 2.82; 12 months: HR, 1.30; 95% CI, 0.69 to 2.46; 24 months: HR, 1.04; 95% CI 0.48 to 2.26; overall p = 0.007). Rates of secondary outcome variables were substantially higher in the revision group compared with patients who survived the hospital stay without a bleeding revision. Concomitant implantation of a temporary right ventricular assist device (p = 0.002) and age (p = 0.028) were independent risk factors for a bleeding revision. CONCLUSIONS: A bleeding revision is associated with significantly reduced survival and substantially increased morbidity during LVAD support. Preoperative, intraoperative, and postoperative prophylactic strategies may help to prevent this life-threatening complication.
BACKGROUND: Few reports have described associations between a bleeding revision and outcomes after implantation of a continuous-flow left ventricular assist device (LVAD). METHODS: We retrospectively analyzed all adult recipients of a continuous-flow LVAD who were operated on between January 2006 and December 2016 at the Division of Cardiac Surgery, Medical University of Vienna (N = 257). LVAD types were HeartWare HVAD (Medtronic, Minneapolis, MN), HeartMate II (Abbott [Thoratec], Abbott Park, IL), and HeartMate 3 (Abbott [Thoratec]). The primary outcome variable was survival during LVAD support. Secondary outcome variables were rates of prolonged ventilation, intensive care unit stay, hospital stay, renal replacement therapy, and stroke. We additionally investigated risk factors for a bleeding revision. RESULTS: Thirty-six patients (14%) underwent surgical revision for bleeding. In a multivariable Cox proportional hazards model, bleeding revision was associated with significantly reduced survival during LVAD support (3 months: hazard ratio [HR], 2.04; 95% confidence interval [CI], 1.20 to 3.48; 6 months: HR, 1.63; 95% CI, 0.95 to 2.82; 12 months: HR, 1.30; 95% CI, 0.69 to 2.46; 24 months: HR, 1.04; 95% CI 0.48 to 2.26; overall p = 0.007). Rates of secondary outcome variables were substantially higher in the revision group compared with patients who survived the hospital stay without a bleeding revision. Concomitant implantation of a temporary right ventricular assist device (p = 0.002) and age (p = 0.028) were independent risk factors for a bleeding revision. CONCLUSIONS: A bleeding revision is associated with significantly reduced survival and substantially increased morbidity during LVAD support. Preoperative, intraoperative, and postoperative prophylactic strategies may help to prevent this life-threatening complication.
Authors: Ali Akil; Stephanie Rehers; Christian Köhler; Lars Richter; Michael Semik; Stephan Ziegeler; Stefan Fischer Journal: J Thorac Dis Date: 2021-08 Impact factor: 2.895
Authors: Philipp Opfermann; Alessia Felli; Christine Schlömmer; Martin Dworschak; Michele Bevilacqua; Mohamed Mouhieddine; Daniel Zimpfer; Andreas Zuckermann; Barbara Steinlechner Journal: Front Med (Lausanne) Date: 2022-02-25