Abstract 3659: Ventricular Assist Device Adverse Events Early After Implant as Predictors of Mortality During Mechanical Support
Background: Ventricular assist devices (VADs) provide effective treatment for end-stage heart failure, however most patients experience one or more major adverse events (AEs) while on VAD support. AEs occurring early after VAD implant may precipitate morbidities that substantially increase the risk for mortality during VAD support. The extent to which the occurrence of AEs during the first 60 days affects subsequent patient mortality has not been established.
Methods: A retrospective analysis was performed using prospectively collected AE data from a single-site database of all patients aged ≥18 years receiving an LVAD or BiVAD from 1996 –2006, who survived >60 days. Fourteen major classes of AEs occurring during this 60-day period were coded using INTERMACS criteria. For each AE, survival for patients who had the AE was compared to survival for those without the AE using Kaplan-Meier analysis.
Results: There were 175 patients included; mean age was 49 years, 77% were male, 88% were white. BiVAD 31%, LVAD 69% (23% HM XVE, 9% HM II, 35% Novacor, 33% Thoratec LVAD), 86% BTT. The occurrence of infection, bleeding, RV failure, reoperation, respiratory events, or renal events during the first 60 days after implant significantly increased the risk for mortality while on VAD support. In comparison, the occurrence of arrhythmias, neurological events, and cardiac tamponade did not increase the risk for mortality.
Conclusions: Specific major AEs, such as infection and bleeding, confer significant long-term effects on mortality risk. Therefore, the future development of VADs, surgical techniques, and peri-operative management should focus on the reduction of these specific AEs found to increase patient mortality.