Abstract 19052: Readmissions After Implantation of Continuous-Flow Left Ventricular Assist Devices: A Comparison Between the HeartMate II and the HeartWare Devices
Background: Readmissions after implantation of continuous-flow left ventricular assist devices (CF-LVAD) are common. The ADVANCE Trial fails to compare readmissions between the HeartMate II (HMII) LVAD and the HeartWare VAD (HVAD). We sought to compare the frequency and causes of early (60 day) readmissions after implantation of these two devices.
Methods: We retrospectively evaluated readmissions at Vanderbilt University Medical Center in a cohort of 65 patients implanted between April 2009 and April 2013 with the HM II LVAD (n= 46) and the HVAD (n=19). All hospitalizations between time of LVAD implant and 60 days were analyzed.
Results: Preoperative patient characteristics (age, LVEF, % reoperation, % ischemic etiology), and preoperative risk stratification (INTERMACS category, Leitz-Miller score, Kormos score) were comparable between groups (all p>0.05). There were 37 readmissions for 28 patients within the first 60 days after device implant. Twenty-six readmissions (70%) occurred between 0-30 days, 11 (30%) between 30-60 days. Overall, the most common reasons for readmission within the first 60 days of implant were Cardiac (heart failure (7) and arrhythmia (6)) n= 13 (35%), other (dehydration (6), pain (1), VAD disconnect (1), elevated INR (2)) n=10 (27%), infection (driveline (2), non-driveline (4)) n=6 (16%), thrombosis (pump (3), hemolysis (1), stroke (1)) n=5 (14%), and bleeding (gastrointestinal (2), hemorrhagic stroke (1)) n= 3 (8%). Readmission frequency in patients with a HMII versus HVAD device type (27 readmissions in 22 patients with HMII vs 10 admissions in 7 patients with HVAD) was not different p=0.40.
Conclusion: Readmission rate after CF-LVAD implantation is frequent (45%) especially within the first 30 days. There are no differences in readmission rate among CF-LVAD types. Understanding these causes is critical for clinical management and institutional efforts to reduce CF-LVAD readmission rates and associated costs.
- © 2013 by American Heart Association, Inc.