Abstract 14408: Pre-Implantation Patient Characteristics Predict Highly Prevalent and Clinically Significant Ventricular Assist Device (VAD) Adverse Events (AEs)
Background: Preoperative factors may predict the prevalence and timing of AEs following VAD implantation; but this relationship has never been thoroughly investigated.
Methods: A retrospective analysis was performed on all adult patients receiving an LVAD or BiVAD at a single institution (1/1996–10/2009). Pre-implantation factors included demographics, type and urgency of device implant, co-morbidities, and pre-implant laboratory and hemodynamic values. All major adverse events (AEs) were defined per INTERMACS criteria. The relationship between pre-implant characteristics and the most prevalent VAD AEs (infection, bleeding, and neurological events) were determined using Kaplan-Meier and Cox Proportional Hazards models.
Results: Among the 286 patients, 77% were male, 87% Caucasian, 27% implanted emergently, 87% bridge to transplant, 30% BiVAD, 50% pulsatile LVAD, and 20% rotary LVAD. Actuarial incidence of significant infections, bleeding, and neurological events through 6 months post-VAD implant was 65%, 52%, and 42%, respectively. Significant (α=.05) and marginally significant (α=.10) risk factors from the multivariable analyses of pre-implant characteristics (entered if p <0.15 in univariable analysis) are shown below.
Conclusions: AEs are differentially associated with pre-implant risk factors. For example, the need for a BiVAD significantly increases the risk for post-implant infections and bleeding, and patients implanted emergently also have an increased risk for infection. Neurologic events are more frequent in patients with hyponatremia, a lower cardiac index, or higher pulmonary vascular resistance. The relationship between the preoperative state and the incidence of VAD AEs is complex and demonstrates that patients with an increasing illness severity at implant (acute presentation, more advanced heart failure, or requirement of biventricular support) have significantly increased rates of major AEs while on VAD support.
- © 2010 by American Heart Association, Inc.