A Multi-Institutional Outcome Analysis of Patients Undergoing Left Ventricular Assist Device Implantation Stratified By Sex and Race

Meeteren, Justin Van; Maltais, Simon; Dunlay, Shannon M.; Haglund, Nicholas; Davis, Mary E.; Pagani, F.D.; Aaronson, K.D.; Cowger, Jennifer; Shah, Palak; Stulak, John M.

doi:10.1016/j.healun.2015.01.014

Cited by 6 publications

(3 citation statements)

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“…After matching, comparable results in survival and transplantations were observed. Contrarily, several previous studies described higher in-hospital mortality rates in women, ranging from 9% to 14.5% (6,12,42). Higher postoperative mortality has been directly correlated to a 5% to 42% incidence of RHF (11,12,15,18) and a 3% to 50% incidence of RVAD implantation in females (11,12,15,19).…”

Section: Discussionmentioning

confidence: 82%

Sex differences in outcomes following less-invasive left ventricular assist device implantation

Mariani¹,

Li²,

Bounader³

et al. 2021

Ann Cardiothorac Surg

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Background: Worse outcomes in women compared to men undergoing left ventricular assist device (LVAD) implantation remain an underestimated problem in heart failure (HF) patients. With device miniaturization, less-invasive LVAD implantation techniques have gained relevance, but their impact on outcomes in women is unknown. This study investigates sex-related differences in patients undergoing LVAD implantation through less-invasive procedures.Methods: This retrospective single-center cohort study included patients who underwent isolated LVAD implantation between 2011 and 2018 through less-invasive techniques. Propensity score matching (PSM) was utilized to balance preoperative heterogeneity. Primary endpoint was two-year survival, and secondary endpoints included long-term survival, surgical outcomes and postoperative adverse events. Results: Baseline analysis of 191 patients (females 18.3%) showed differences in terms of age [female (median, 52; IQR, 47-61); male (median, 58.5; IQR, 49-66); P=0.005], underlying diagnosis (P<0.001), INTERMACS profile (P=0.009), history of previous cardiac surgery (P=0.049) and preoperative creatinine values [female (median, 110; IQR, 71-146); male (median, 126; IQR, 9-168); P=0.049]. Over a follow-up of 460.68 patient-years, Kaplan-Meyer analysis showed better survival in females (P=0.027) and a similarprobability of cardiac transplantation (P=0.288). After PSM, females showed higher needs for intraoperative fresh frozen plasma (P=0.044) and platelets (P=0.001) but comparable postoperative outcomes. No sexrelated differences were noticed regarding two-year outcomes, long-term survival and adverse events. LVADrelated infections remained the most common complication with males experiencing more pump infections than women (P=0.050).Conclusions: Patients receiving less-invasive LVAD implantation do not show significant sex-related differences in short and long-term outcomes and survival. Prospective studies are needed to evaluate the role of less-invasive techniques in reducing sex-based disparities after LVAD implantation.

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Section: Discussionmentioning

confidence: 82%

Sex differences in outcomes following less-invasive left ventricular assist device implantation

Mariani¹,

Li²,

Bounader³

et al. 2021

Ann Cardiothorac Surg

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“…While data from heart failure and CABG surgery suggest worse outcomes in the AA population, studies among LVAD recipients have not replicated these findings. Meeteren et al 25 demonstrated that despite higher rates of New York Heart Association functional class IV among AA compared to Caucasians at baseline, no significant differences in survival at 1, 3, or 5 years after LVAD implantation were present. Small studies have also suggested that 30 days mortality was not significantly different among racial groups after LVAD implantation 26,27 .…”

Section: Discussionmentioning

confidence: 99%

Racial disparities in in‐hospital outcomes after left ventricular assist device implantation

et al. 2020

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Background Previous studies of patients undergoing various cardiac surgeries demonstrated worse outcomes among African‐American (AA) patients. It remains unclear if the race is a predictor of outcomes among left ventricular assist device (LVAD) recipients. Methods Patients who underwent LVAD implantation between 2010 and 2017 were identified using the National Inpatient Sample. The race was classified as Caucasians vs AA vs Hispanics, and endpoints were in‐hospital outcomes, length of stay, and cost. Procedure‐related complications were identified via the International Classification of Diseases‐9 (ICD‐9) and ICD‐10 coding and analysis performed via mixed‐effect models. Results A total of 27 132 adults (5114 unweighted) underwent LVAD implantation in the U.S. between 2010 and 2017, including Caucasians (63.8%), AA (23.8%), and Hispanics (6%). The number of LVAD implantations increased in both Caucasians and AA during the study period. AA LVAD recipients were younger, with higher rates of females and mostly comorbidities, but lower rates of coronary artery disease and bypass grafting compared to Caucasians and Hispanics. Medicaid and median income at the lowest quartile were more frequent among AA LVAD recipients. We did not identify differences in stroke, bleeding complications, tamponade, infectious complications, acute kidney injury requiring hemodialysis, and in‐hospital mortality among racial groups. AA LVAD recipients had lower rates of routine discharge than Caucasians and Hispanics, longer length of stay than Caucasians, but similar cost of hospitalization. After adjustment for clinical comorbidities, race was not a predictor of in‐hospital mortality. Conclusion We identified differences in clinical characteristics but not in in‐hospital complications among LVAD recipients of a different races.

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“…Most previous reports that evaluated risk factors for stroke in patients with LVAD were comprised of only white and/or black patients. In addition, there has been only one study that has compared the incidence of stroke between white and black patients with LVAD, 23 and a study with Asian patients has never been reported. The incidence of cerebrovascular accidents in the general population is different depending on racial differences.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Cerebral Microbleeds in Patients With Continuous‐Flow Left Ventricular Assist Devices

Yoshioka

Okazaki

Toda

et al. 2017

JAHA

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BackgroundThe prevalence of cerebral microbleeds (CMBs) in gradient echo T2*‐weighted brain MRI has a positive correlation with hemorrhagic stroke incidence. However, the prevalence of CMBs in patients with left ventricular assist devices (LVADs) has not been evaluated. We evaluated the prevalence of CMBs and the relationship with hemorrhagic stroke incidence in patients with LVADs.Method and ResultsWe analyzed results from brain MRI in prospective examinations of 35 consecutive patients who had undergone LVAD explantation for heart transplantation or recovery since 2011. The number and distribution of CMBs were counted, then the relationship between baseline characteristics and adverse events during LVAD support were analyzed. The mean age was 37.7±12.4 years and the mean LVAD duration was 2.43±1.08 years. Thirty‐four (97%) patients had at least one CMB. Nine (26%) developed hemorrhagic stroke during LVAD support, and patients with hemorrhagic stroke had a significantly greater number of CMBs compared with patients without hemorrhagic stroke (5 [interquartile range (IQR), 4–7] versus 9 [IQR, 5–23]; odds ratio 1.14 [95% Confidence Interval (CI), 1.02–1.32], P=0.05). There was no significant relationship between age, LVAD support duration, or systolic blood pressure during LVAD. However, patients who had at least one episode of bacteremia (9 [IQR, 4–16] versus 5 [IQR, 3–7], P=0.06) and pump pocket infection (14 [IQR, 4–27] versus 5 [IQR, 3–7], P=0.08) showed a trend toward a greater number of CMBs than patients without bacteremia.ConclusionsThirty‐four (97%) patients with continuous‐flow LVAD had at least one CMB, and the number of CMBs were more prevalent in patients with hemorrhagic stroke and in patients with LVAD‐related infection.

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A Multi-Institutional Outcome Analysis of Patients Undergoing Left Ventricular Assist Device Implantation Stratified By Sex and Race

Cited by 6 publications

References 0 publications

Sex differences in outcomes following less-invasive left ventricular assist device implantation

Sex differences in outcomes following less-invasive left ventricular assist device implantation

Racial disparities in in‐hospital outcomes after left ventricular assist device implantation

Prevalence of Cerebral Microbleeds in Patients With Continuous‐Flow Left Ventricular Assist Devices

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