Teruhiko Imamura1, Koichiro Kinugawa2, Minoru Ono3, Osamu Kinoshita3, Norihide Fukushima4, Akira Shiose5, Yoshiro Matsui6, Kenji Yamazaki7, Yoshikatsu Saiki8, Akihiko Usui9, Hiroshi Niinami10, Goro Matsumiya11, Hirokuni Arai12, Yoshiki Sawa13. 1. Department of Medicine, University of Chicago Medical Center. 2. Second Department of Internal Medicine, Toyama University. 3. Department of Cardiac Surgery, the University of Tokyo Hospital. 4. Department of Transplant Medicine, National Cerebral and Cardiovascular Center. 5. Department of Cardiovascular Surgery, Kyushu University. 6. Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine. 7. Department of Cardiovascular Surgery, Tokyo Women's Medical University. 8. Department of Cardiovascular Surgery, Tohoku University. 9. Department of Cardiovascular Surgery, Nagoya University Hospital. 10. Department of Cardiovascular Surgery, Saitama Kokusai Medical Center. 11. Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine. 12. Department of Cardiovascular Surgery, Tokyo Medical and Dental University. 13. Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine.
Abstract
BACKGROUND: Hemocompatibility-related adverse events (HRAEs) are substantial issues in patients with left ventricular assist devices (LVADs). Atrial fibrillation (AF) is associated with worse prognosis in patients with heart failure (HF), but its effect on HRAEs following LVAD implantation remain uncertain.Methods and Results: Data from the Japanese Mechanically Assisted Circulatory Support registry of consecutive patients who received HeartMate II LVADs and were followed for 1 year were retrospectively reviewed. Among 190 patients, 23 had AF and 167 had sinus rhythm. The AF group had comparable baseline characteristics with the non-AF group except for their higher age (53 vs. 42 years, P<0.001). Following LVAD implantation, most cases of AF (73%) persisted. Antiplatelet therapy, anticoagulation therapy, and LVAD speed following LVAD implantation were comparable between groups (P>0.05 for all). The 1-year survival free from HRAEs was comparable between groups (83% vs. 76%, P=0.52). Event rates of the breakdown of HRAEs were comparable between groups except for a relatively higher rate of surgically managed pump thrombosis in the AF group (0.16 vs. 0.04, incidence rate ratio 3.75, 95% confidence interval 0.87-16.1, P=0.075). These trends still remained with propensity score-matched comparison. CONCLUSIONS: Existence of AF had no effect on the development of HRAEs following LVAD implantation. The need to aggressively treat AF before or after LVAD implantation needs further investigation.
BACKGROUND: Hemocompatibility-related adverse events (HRAEs) are substantial issues in patients with left ventricular assist devices (LVADs). Atrial fibrillation (AF) is associated with worse prognosis in patients with heart failure (HF), but its effect on HRAEs following LVAD implantation remain uncertain.Methods and Results: Data from the Japanese Mechanically Assisted Circulatory Support registry of consecutive patients who received HeartMate II LVADs and were followed for 1 year were retrospectively reviewed. Among 190 patients, 23 had AF and 167 had sinus rhythm. The AF group had comparable baseline characteristics with the non-AF group except for their higher age (53 vs. 42 years, P<0.001). Following LVAD implantation, most cases of AF (73%) persisted. Antiplatelet therapy, anticoagulation therapy, and LVAD speed following LVAD implantation were comparable between groups (P>0.05 for all). The 1-year survival free from HRAEs was comparable between groups (83% vs. 76%, P=0.52). Event rates of the breakdown of HRAEs were comparable between groups except for a relatively higher rate of surgically managed pump thrombosis in the AF group (0.16 vs. 0.04, incidence rate ratio 3.75, 95% confidence interval 0.87-16.1, P=0.075). These trends still remained with propensity score-matched comparison. CONCLUSIONS: Existence of AF had no effect on the development of HRAEs following LVAD implantation. The need to aggressively treat AF before or after LVAD implantation needs further investigation.
Entities:
Keywords:
HeartMate; Hemocompatibility; Japanese Mechanically Assisted Circulatory Support Registry (J-MACS); Left ventricular assist device (LVAD)