To assess LVAD complications and their overall effect on mortality and determine factors associated with development of early and long-term complications.
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.
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).
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
AuthorsTolulope A. Adesiyun, Rhondalyn C. McLean, Ryan J. Tedford, Glenn J.R. Whitman, Chris M. Sciortino, John V. Conte, Ashish S. Shah, Stuart D. Russell
- • Accepted on 21/06/2017
- • Available online on 02/08/2017
- • Published in print on 27/10/2017
This article is available as full text PDF.
- Adesiyun, Tolulope A. [PubMed] [Google Scholar] 1
- McLean, Rhondalyn C. [PubMed] [Google Scholar] 2, 3
- Tedford, Ryan J. [PubMed] [Google Scholar] 3, 4
- Whitman, Glenn J.R. [PubMed] [Google Scholar] 5
- Sciortino, Chris M. [PubMed] [Google Scholar] 5
- Conte, John V. [PubMed] [Google Scholar] 5
- Shah, Ashish S. [PubMed] [Google Scholar] 5, 6
- Russell, Stuart D. [PubMed] [Google Scholar] 3, * Corresponding Author (firstname.lastname@example.org)
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