Detailed association between peripheral arterial disease and comorbidity following left ventricular assist device implantation.

To the editor:

Ullah and colleagues demonstrated using the National Inpatient Sample database that the existence of peripheral arterial disease was associated with mortality and morbidity following durable left ventricular assist device (LVAD) implantation [1]. Several concerns should improve the implications of their findings.

Patients with peripheral arterial disease receive antiplatelet and anticoagulation therapies in general, and LVAD patients also receive similar medications to prevent thromboembolic comorbidity [2]. I would like to know the difference in these medications between those with peripheral arterial disease and those without during LVAD supports. Appropriate antithrombotic regimens to prevent both bleeding and thromboembolic events during LVAD supports remain future concerns [3], particularly for those with peripheral arterial diseases.

LVAD utilization in patients with peripheral arterial disease is increasing during the past ten years [1]. If their mortality has remained unchanged, LVAD implantation for such population might not be recommended. Do the authors have the trend of their annual mortality?

Their findings would be helpful for risk stratification and appropriate patient selection for LVAD therapy. The authors recommend the screening of peripheral arterial disease prior to LVAD implantation. Do the authors believe that preoperative aggressive intervention to peripheral arterial disease would improve the clinical outcomes following LVAD implantation?

Disclosure

None.