Causes and predictors of early mortality in patients treated with left ventricular assist device implantation in the European Registry of Mechanical Circulatory Support (EUROMACS)

Akın, Şakir; Soliman, Osama; By, Theo M M H de; Muslem, Rahatullah; Tijssen, Jan G.P.; Schoenrath, Felix; Meyns, Bart; Gummert, Jan; Mohaçsi, Paul; Çalışkan, Kadir

doi:10.1007/s00134-020-05939-1

Cited by 52 publications

(41 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Akin et al . found that ischaemic cardiomyopathy was more common in patients who died within 90 days after LVAD implantation when compared with other cardiomyopathies 12 . This suggested a possible worse prognosis for patients with ischaemic cardiomyopathy.…”

Section: Discussionmentioning

confidence: 93%

“…Akin et al found that ischaemic cardiomyopathy was more common in patients who died within 90 days after LVAD implantation when compared with other cardiomyopathies. 12 This suggested a possible worse prognosis for patients with ischaemic cardiomyopathy. However, 1 year survival of patients with ischaemic and dilated cardiomyopathy was not significantly different in a retrospective study.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Propensity score‐based analysis of long‐term outcome of patients on HeartWare and HeartMate 3 left ventricular assist device support

et al. 2021

View full text Add to dashboard Cite

Aims Left ventricular assist device therapy has become the cornerstone in the treatment of end-stage heart failure and is increasingly used as destination therapy next to bridge to transplant or recovery. HeartMate 3 (HM3) and HeartWare (HVAD) are centrifugal continuous flow devices implanted intrapericardially and most commonly used worldwide. No randomized controlled trials have been performed yet. Analysis based on large registries may be considered as the best alternative but has the disadvantage of different standard of care between centres and missing data. Bias is introduced, because the decision which device to use was not random, even more so because many centres use only one type of left ventricular assist device. Therefore, we performed a propensity score (PS)-based analysis of long-term clinical outcome of patients that received HM3 or HVAD in a single centre. Methods and results Between December 2010 and December 2019, 100 patients received HVAD and 81 patients HM3 as primary implantation at the University Medical Centre Utrecht. We performed PS matching with an extensive set of covariates, resulting in 112 matched patients with a median follow-up of 28 months. After PS matching, survival was not significantly different (P = 0.21) but was better for HM3. The cumulative incidences for haemorrhagic stroke (P = 0.01) and pump thrombosis (P = 0.02) were significantly higher for HVAD patients. The cumulative incidences for major bleeding, ischaemic stroke, right heart failure, and driveline infection were not different between the groups. We found no interaction between the surgeon who performed the implantation and survival (P = 0.59, P = 0.78, and P = 0.89). Sensitivity analysis was performed, by PS matching without patients on preoperative temporary support resulting in 74 matched patients. This also resulted in a non-significant difference in survival (P = 0.07). The PS-adjusted Cox regression showed a worse but non-significant (P = 0.10) survival for HVAD patients with hazard ratio 1.71 (95% confidence interval 0.91-3.24). Conclusions Survival was not significantly different between both groups after PS matching, but was better for HM3, with a significantly lower incidence of haemorrhagic stroke and pump thrombosis for HM3. These results need to be interpreted carefully, because matching may have introduced greater imbalance on unmeasured covariates. A multicentre approach of carefully selected centres is recommended to enlarge the number of matched patients.

show abstract

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Propensity score‐based analysis of long‐term outcome of patients on HeartWare and HeartMate 3 left ventricular assist device support

et al. 2021

View full text Add to dashboard Cite

show abstract

“…These causes of death are not particularly device‐specific, and therefore, are most likely related to patient medical history or patient management. For example, Sabashnikov et al found that higher preoperative central venous pressure and older age were the only independent risk factors for early mortality after CF‐LVAD implantation 21 ; and Ankin et al found several demographic (age, race, gender, and INTERMACS class), laboratory and hemodynamic variables that independently predict early mortality 22 . However, the current study’s analysis found that HM3 patients demonstrated a significantly lower in‐hospital mortality ( P = .03) than HW patients following CF‐LVAD exchange.…”

Section: Discussionmentioning

confidence: 99%

Continuous‐flow LVAD exchange to a different pump model: Systematic review and meta‐analysis of the outcomes

et al. 2021

View full text Add to dashboard Cite

Despite improved outcomes of modern continuous‐flow left ventricular assist devices (CF‐LVADs), device exchange is still needed for various indications. While the majority of CF‐LVADs are exchanged to the same model, exchange to a different pump model is occasionally warranted. In this meta‐analysis, we sought to consolidate the existing evidence to better elucidate the indications and outcomes in these cases. A comprehensive systematic search of adult patient cohorts who underwent CF‐LVAD exchange to a different CF‐LVAD model was performed. Study‐level data from 10 studies comprising 98 patients were extracted and pooled for analysis. Mean patient age was 58 (95% CI: 48‐65) and 81% were male. Indication for initial CF‐LVAD was ischemic cardiomyopathy in 45% (34‐57). Initial device was HeartMate II LVAD (HMII) in 93 (94.9%) and HeartWare HVAD (HW) in 5 (5.1%) patients. After mean CF‐LVAD support time of 18.8 (15.2‐22.4) months, exchange indications included thrombosis in 71% (43‐89), infection in 21% (8‐47) and device malfunction in 12% (7‐21). HMII to HW exchange occurred in 53 (54.1%) patients, HMII to HeartMate III (HM3) in 32 (32.7%), and HM II to either HW or HM3 in 13 (13.2%) patients. Postoperatively, right ventricular assist device was required in 16% (8‐32). Overall, 20% (8‐40) of patients experienced a stroke, while HW patients had a significantly higher stroke incidence than HM3 patients (HW: 21% (8‐47) vs. HM3: 5% (1‐24), P < .01). Overall 30‐day mortality was 10% (6‐17), while HW had a significantly worse 30‐day mortality than HM3 (HW: 13% (7‐24) vs. HM3: 5% (1‐24), P = .03). Following device exchange from a different CF‐LVAD model, HM3 is associated with lower stroke and higher survival when compared to HW.

show abstract

“…The univariate analysis revealed that the female gender is one of the independent mortality predictors. 24 …”

Section: Discussionmentioning

confidence: 99%

Impact of gender in patients with continuous-flow left ventricular assist device therapy in end-stage heart failure

Szczechowicz¹,

Oßwald

Rad

et al. 2021

Int J Artif Organs

View full text Add to dashboard Cite

Background: There is an ongoing debate about the influence of the female gender on postoperative outcomes after durable left ventricular assist device (LVAD) implantation. Despite the differences in pathophysiology of heart failure in females, therapy concepts are the same as in the male population. The aim of this study was to investigate the role of the female gender in surgical heart failure therapy. Materials and methods: Between August 2010 and January 2020, 207 patients were treated with durable LVAD at out institution. We matched 111 patients in two groups to compare the outcomes in male and female patients and to stratify the risk factors of mortality. Results: The groups were matched 2:1 and were comparable after matching. We found no difference in in-hospital and follow-up mortality between male and female patients. Postoperative adverse events and complications were found to be unvaried across male and female patients. Female patients had higher rates of postoperative LVAD-thrombosis compared to their male counterparts (13.5% vs 0, p = 0.001) and the rates of renal replacement therapy lasting over 90 days were also higher in the female group (33.8% vs 56.8%, p = 0.021). Furthermore, the female gender was not an independent predictor neither of in-hospital nor follow-up mortality. Conclusions: Durable continuous flow left ventricular assist devices as a bridge to transplantation or recovery in female patients are associated with a higher risk of acute kidney injury requiring RRT and are at a higher risk of LVAD-thrombosis. Nevertheless, survival rates between genders are similar.

show abstract

Causes and predictors of early mortality in patients treated with left ventricular assist device implantation in the European Registry of Mechanical Circulatory Support (EUROMACS)

Cited by 52 publications

References 39 publications

Propensity score‐based analysis of long‐term outcome of patients on HeartWare and HeartMate 3 left ventricular assist device support

Propensity score‐based analysis of long‐term outcome of patients on HeartWare and HeartMate 3 left ventricular assist device support

Continuous‐flow LVAD exchange to a different pump model: Systematic review and meta‐analysis of the outcomes

Impact of gender in patients with continuous-flow left ventricular assist device therapy in end-stage heart failure

Contact Info

Product

Resources

About