P Elliott Miller1,2, Cesar Caraballo3, Neal G Ravindra4,5, Catherine Mezzacappa6, Megan McCullough6, Jadry Gruen6, Andrew Levin6, Samuel Reinhardt1, Ayyaz Ali7, Nihar R Desai1,3, Tariq Ahmad1,3. 1. Section of Cardiovascular Medicine (P.E.M., S.R., N.R.D., T.A.), Yale University School of Medicine, New Haven, CT. 2. Yale National Clinician Scholars Program (P.E.M.), Yale University School of Medicine, New Haven, CT. 3. Center for Outcomes Research & Evaluation (CORE) (C.C., N.R.D., T.A.), Yale University School of Medicine, New Haven, CT. 4. Department of Molecular Biophysics and Biochemistry (N.G.R.), Yale University School of Medicine, New Haven, CT. 5. Integrated Graduate Program in Physical and Engineering Biology (N.G.R.), Yale University School of Medicine, New Haven, CT. 6. Department of Internal Medicine (C.M., M.M., J.G., A.L.), Yale University School of Medicine, New Haven, CT. 7. Section of Cardiovascular Surgery (A.A.), Yale University School of Medicine, New Haven, CT.
Abstract
BACKGROUND: The impact of respiratory failure on patients undergoing left ventricular assist device (LVAD) implantation is not well understood, especially since these patients were excluded from landmark clinical trials. We sought to evaluate the associations between immediate preimplant and postimplant respiratory failure on outcomes in advanced heart failure patients undergoing LVAD implantation. METHODS AND RESULTS: We included all patients in the Interagency Registry for Mechanically Assisted Circulatory Support who were implanted with continuous-flow LVADs from 2008 to 2016. Of the 16 362 patients who underwent continuous-flow LVAD placement, 906 (5.5%) required preimplant intubation within 48 hours before implantation, and 1001 (6.1%) patients developed respiratory failure within 1 week after implantation. A higher proportion of patients requiring preimplant intubation were Interagency Registry for Mechanically Assisted Circulatory Support profile 1, required mechanical circulatory support, and presented with cardiac arrest or myocardial infarction (P<0.001, all). At 1 year, 54.3% of patients intubated preimplant were alive without transplant, 20.1% had been transplanted, and 24.2% died before transplant. Patients requiring preimplant intubation had higher rates of postimplant complications, including bleeding, stroke, and right ventricular assist device implantation (P<0.01 for all). Among Interagency Registry for Mechanically Assisted Circulatory Support profile 1 patients, preimplant intubation incurred additional risk of death at 1 year compared with Interagency Registry for Mechanically Assisted Circulatory Support profile 1 patients not intubated (hazard ratio, 1.37 [95% CI, 1.13-1.65]; P=0.001). After multivariable analysis, both preimplant intubation (hazard ratio, 1.20 [95% CI, 1.03-1.41]; P=0.021) and respiratory failure within 1 week (hazard ratio, 2.54 [95% CI, 2.26-2.85]; P<0.001) were associated with higher all-cause 1-year mortality. CONCLUSIONS: Respiratory failure both before and after LVAD implantation identifies an advanced heart failure population with significantly worse 1-year mortality. This data might be helpful in counseling patients and their families about expectations about life with an LVAD.
BACKGROUND: The impact of respiratory failure on patients undergoing left ventricular assist device (LVAD) implantation is not well understood, especially since these patients were excluded from landmark clinical trials. We sought to evaluate the associations between immediate preimplant and postimplant respiratory failure on outcomes in advanced heart failurepatients undergoing LVAD implantation. METHODS AND RESULTS: We included all patients in the Interagency Registry for Mechanically Assisted Circulatory Support who were implanted with continuous-flow LVADs from 2008 to 2016. Of the 16 362 patients who underwent continuous-flow LVAD placement, 906 (5.5%) required preimplant intubation within 48 hours before implantation, and 1001 (6.1%) patients developed respiratory failure within 1 week after implantation. A higher proportion of patients requiring preimplant intubation were Interagency Registry for Mechanically Assisted Circulatory Support profile 1, required mechanical circulatory support, and presented with cardiac arrest or myocardial infarction (P<0.001, all). At 1 year, 54.3% of patients intubated preimplant were alive without transplant, 20.1% had been transplanted, and 24.2% died before transplant. Patients requiring preimplant intubation had higher rates of postimplant complications, including bleeding, stroke, and right ventricular assist device implantation (P<0.01 for all). Among Interagency Registry for Mechanically Assisted Circulatory Support profile 1 patients, preimplant intubation incurred additional risk of death at 1 year compared with Interagency Registry for Mechanically Assisted Circulatory Support profile 1 patients not intubated (hazard ratio, 1.37 [95% CI, 1.13-1.65]; P=0.001). After multivariable analysis, both preimplant intubation (hazard ratio, 1.20 [95% CI, 1.03-1.41]; P=0.021) and respiratory failure within 1 week (hazard ratio, 2.54 [95% CI, 2.26-2.85]; P<0.001) were associated with higher all-cause 1-year mortality. CONCLUSIONS:Respiratory failure both before and after LVAD implantation identifies an advanced heart failure population with significantly worse 1-year mortality. This data might be helpful in counseling patients and their families about expectations about life with an LVAD.
Authors: Thomas S Metkus; P Elliott Miller; Carlos L Alviar; Vivian M Baird-Zars; Erin A Bohula; Paul C Cremer; Daniel A Gerber; Jacob C Jentzer; Ellen C Keeley; Michael C Kontos; Venu Menon; Jeong-Gun Park; Robert O Roswell; Steven P Schulman; Michael A Solomon; Sean van Diepen; Jason N Katz; David A Morrow Journal: Crit Care Explor Date: 2020-09-17
Authors: P Elliott Miller; Clancy W Mullan; Fouad Chouairi; Sounok Sen; Katherine A Clark; Samuel Reinhardt; Michael Fuery; Muhammad Anwer; Arnar Geirsson; Richard Formica; Joseph G Rogers; Nihar R Desai; Tariq Ahmad Journal: Eur Heart J Acute Cardiovasc Care Date: 2021-10-27
Authors: P Elliott Miller; Alexander Thomas; Thomas J Breen; Fouad Chouairi; Yukiko Kunitomo; Faisal Aslam; Abdulla A Damluji; Nandan S Anavekar; Joseph G Murphy; Sean van Diepen; Gregory W Barsness; Joseph Brennan; Jacob Jentzer Journal: Am J Med Date: 2020-10-28 Impact factor: 4.965
Authors: Avirup Guha; Cesar Caraballo; Prantesh Jain; P Elliott Miller; Jocelyn Owusu-Guha; Katherine A A Clark; Eric J Velazquez; Tariq Ahmad; Lauren A Baldassarre; Daniel Addison; Neal L Weintraub; Nihar R Desai Journal: ESC Heart Fail Date: 2021-05-13