Karthik Gonuguntla1, Shivaraj Patil2, Richard Gregory Cowden3, Manish Kumar4, Chaitanya Rojulpote5, Abhijit Bhattaru6, John Glenn Tiu7, Peter Robinson7. 1. Department of Internal Medicine and Cardiology, Calhoun Cardiology Center University of Connecticut, Farmington, CT, USA. karthikg.75@gmail.com. 2. Department of Internal Medicine and Cardiology, Calhoun Cardiology Center University of Connecticut, Farmington, CT, USA. 3. Department of Psychology, University of the Free State, Bloemfontein, 9301, South Africa. 4. Department of Geriatrics, University of Connecticut, Farmington, CT, USA. 5. Department of Nuclear Cardiology & Cardiovascular Molecular Imaging, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 6. Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 7. Department of Cardiology, Calhoun Cardiology Center University of Connecticut, Farmington, CT, USA.
Abstract
BACKGROUND: A left ventricular assist device (LVAD) is used to support patients with end-stage heart failure. AIMS: To examine the role of comorbidities and complications in predicting in-hospital mortality since the introduction of continuous flow (CF)-LVAD. METHODS: The Nationwide Inpatient Sample was queried from 2010 to 2014 using International Classification of Disease-9 code for LVAD among patients 18 years or older. The sample consisted of 2,359 patients (mean age = 55 ± 13.7 years, 76.8% men, 59.3% Caucasian). RESULTS: Comparative analysis revealed mortality did not differ from 2010 to 2014 (p = 0.653). Increases in comorbidities of atrial fibrillation, acute kidney injury, mechanical ventilation, body mass index ≥ 25, cerebrovascular disease, and mild liver disease were evidenced over the 5-year period (p values ≤ 0.049). Multivariate analysis showed that significant predictors of mortality were comorbid hemodialysis (AOR = 7.62, 95% CI [4.78, 12.27]), cerebrovascular disease (AOR = 5.38, 95% CI [3.49, 8.26]), mechanical ventilation (AOR = 3.83, 95% CI [2.84, 5.18]), mild liver disease (AOR = 1.96, 95% CI [1.38, 2.76]), and acute kidney injury (AOR = 1.62, 95% CI [1.16, 2.28]). Predictive complications included disseminated intravascular coagulation (AOR = 6.41, 95% CI [2.79, 6.84]), sepsis (AOR = 4.37, 95% CI [2.79, 6.84]), septic shock (AOR = 3.9, 95% CI [2.11, 7.59]), and gastrointestinal bleed (AOR = 1.81, 95% CI [1.11, 2.93]). CONCLUSIONS: CF-LVADs have not reduced mortality, possibly due to utilization in patients with comorbid conditions. Future trials are necessary for improved patient selection and reduced post-procedural complications.
BACKGROUND: A left ventricular assist device (LVAD) is used to support patients with end-stage heart failure. AIMS: To examine the role of comorbidities and complications in predicting in-hospital mortality since the introduction of continuous flow (CF)-LVAD. METHODS: The Nationwide Inpatient Sample was queried from 2010 to 2014 using International Classification of Disease-9 code for LVAD among patients 18 years or older. The sample consisted of 2,359 patients (mean age = 55 ± 13.7 years, 76.8% men, 59.3% Caucasian). RESULTS: Comparative analysis revealed mortality did not differ from 2010 to 2014 (p = 0.653). Increases in comorbidities of atrial fibrillation, acute kidney injury, mechanical ventilation, body mass index ≥ 25, cerebrovascular disease, and mild liver disease were evidenced over the 5-year period (p values ≤ 0.049). Multivariate analysis showed that significant predictors of mortality were comorbid hemodialysis (AOR = 7.62, 95% CI [4.78, 12.27]), cerebrovascular disease (AOR = 5.38, 95% CI [3.49, 8.26]), mechanical ventilation (AOR = 3.83, 95% CI [2.84, 5.18]), mild liver disease (AOR = 1.96, 95% CI [1.38, 2.76]), and acute kidney injury (AOR = 1.62, 95% CI [1.16, 2.28]). Predictive complications included disseminated intravascular coagulation (AOR = 6.41, 95% CI [2.79, 6.84]), sepsis (AOR = 4.37, 95% CI [2.79, 6.84]), septic shock (AOR = 3.9, 95% CI [2.11, 7.59]), and gastrointestinal bleed (AOR = 1.81, 95% CI [1.11, 2.93]). CONCLUSIONS:CF-LVADs have not reduced mortality, possibly due to utilization in patients with comorbid conditions. Future trials are necessary for improved patient selection and reduced post-procedural complications.
Authors: Joel C Boudreaux; Marian Urban; Anthony W Castleberry; John Y Um; Michael J Moulton; Aleem Siddique Journal: J Card Surg Date: 2022-07-21 Impact factor: 1.778