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Long-term follow-up of continuous flow left ventricular assist devices: complications and predisposing risk factors

Abstract

Purpose

To assess LVAD complications and their overall effect on mortality and determine factors associated with development of early and long-term complications.

Methods

A retrospective cohort study of patients who underwent continuous flow LVAD placement between January 1, 2000 and November 30, 2013 was performed. The incidence of complications (sepsis or bacteremia, driveline infections, gastrointestinal bleeding, pump thrombosis, cerebrovascular accidents and anemia requiring transfusion) was collected and logistic regression and Cox proportional hazards analyses were performed.

Results

108 patients met our inclusion criteria. Median length of follow-up was 2.2 years. In univariable logistic regression analysis, higher blood urea nitrogen (BUN), creatinine clearance <60, no prior inotrope use, higher INTERMACS class and lower platelet count were associated with early complications. On multivariable analysis, factors associated with early complications included higher BUN (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.001-1.06 per mg/dL BUN), no prior inotrope use (OR 4.92, 95% CI 1.64- 14.7) and lower platelet count (OR 4.29, 95% CI 1.45-12.7 <200 10(3) cu mm); 24% of patients developed early complications and 18.5% developed an early and late complication. Early complications were significantly associated with death (p = 0.017). The presence of 2 or more complications was associated with a 2.7-fold increase in the odds of death (p = 0.016) and odds of death increased by 20% with each subsequent complication (p = 0.004).

Conclusions

LVADs are associated with significant long-term complications including stroke and sepsis and minimizing time on LVADs may decrease the risk of complications and subsequent morbidity and mortality.

Int J Artif Organs 2017; 40(11): 622 - 628

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.5301/ijao.5000628

Authors

Tolulope A. Adesiyun, Rhondalyn C. McLean, Ryan J. Tedford, Glenn J.R. Whitman, Chris M. Sciortino, John V. Conte, Ashish S. Shah, Stuart D. Russell

Article History

Disclosures

Financial support: No grants or funding have been received for this study.
Conflict of interest: None of the authors has financial interest related to this study to disclose. Dr. Russell was a consultant and has received research support from Thoratec in the past. Dr. Whitman has received a grant from Abbott in the past.

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Authors

Affiliations

  •  Johns Hopkins University School of Medicine, Baltimore, MD - USA
  •  Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA - USA
  •  Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD - USA
  •  Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC - USA
  •  Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, MD - USA
  •  Division of Cardiac Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN - USA

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