Impact of Center Left Ventricular Assist Device Volume on Outcomes After Implantation

Cowger, Jennifer; Stulak, John M.; Shah, Palak; Dardas, Todd; Pagani, Francis D.; Dunlay, Shannon M.; Maltais, Simon; Aaronson, Keith D.; Singh, Ramesh; Mokadam, Nahush A.; Kirklin, James K.; Salerno, Christopher T.

doi:10.1016/j.jchf.2017.05.011

Cited by 57 publications

(46 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several pediatric cardiology studies have noted improved surgical outcomes in higher‐volume centers, particularly among more complex procedures such as the Norwood operation 15,16 . Similarly, studies in adult VAD patients found a correlation with higher post‐VAD mortality at low‐volume centers, defined as ≤10 VADs per year, compared with high‐volume centers (>50 implants/year) 17 . In pediatrics, most centers are low‐volume, with 74% of our survey respondents at centers with ≤10 VADs/year and 78% of respondents at centers with ≤5 SV implants over the previous 3 years.…”

Section: Discussionmentioning

confidence: 93%

Variability in clinical decision‐making for ventricular assist device implantation in pediatrics

Joong

Gossett

Blume

et al. 2020

Pediatric Transplantation

View full text Add to dashboard Cite

Background: Minimal data exist on clinical decision-making in VAD implantation in pediatrics. This study aims to identify areas of consensus/variability among pediatric VAD physicians in determining eligibility and factors that guide decision-making. Methods: An 88-item survey with clinical vignettes was sent to 132 pediatric HT cardiologists and surgeons at 37 centers. Summary statistics are presented for the variables assessed. Results: Total respondents were 65 (72% cardiologists, 28% surgeons) whose centers implanted 1-5 (34%), 6-10 (40%), or >10 (26%) VADs in the past year. Consensus varied by patients' age, diagnosis, and Pedimacs profile. Highest agreement to offer VAD (97%) was a mechanically ventilated teenager with dilated cardiomyopathy. Patients stable on inotropes were less likely offered VAD (11%-25%). SV infant with Pedimacs profile 2 had the most varied responses: 37% offered VAD; estimated survival ranged from 15% to 90%. Variables considered for VAD eligibility included mild developmental delays (100% offered VAD), moderate-severe behavioral concerns (46%), cancer in remission >2 years (100%), active malignancy with good prognosis (68%) or uncertain prognosis (36%), and BMI >35 (74%) or <15 (69%). Most respondents (91%) would consider destination therapy VADs in pediatrics, though not currently feasible at 1/3 of centers. Factors with greatest influence on decision-making included HT candidacy, families' goals of care, and risks of complications. Conclusions: Significant variation exists among pediatric VAD physicians when determining VAD eligibility and estimating survival, which can lead to differences in access to emerging technologies across institutions. Further work is needed to understand and mitigate these differences.

show abstract

Section: Discussionmentioning

confidence: 93%

Variability in clinical decision‐making for ventricular assist device implantation in pediatrics

Joong

Gossett

Blume

et al. 2020

Pediatric Transplantation

View full text Add to dashboard Cite

show abstract

“… 5 Similarly, hospital volume is strongly associated with survival after the placement of left ventricular assist device (LVAD). 6 Emergency surgical procedures have a disproportionately high risk for mortality and an important question is whether centers with different emergency surgery volumes have equivalent outcomes. The published literature is not definitive on this topic.…”

Section: Discussionmentioning

confidence: 99%

Clinical Practice Variation and Outcomes for Stanford Type A Aortic Dissection Repair Surgery in Maryland: Report from a Statewide Quality Initiative

et al. 2020

View full text Add to dashboard Cite

Background Stanford Type A aortic dissection repair surgery is associated with high mortality and clinical practice remains variable among hospitals. Few studies have examined statewide practice variation. Methods Patients who had Stanford Type A aortic dissection repair surgery in Maryland between July 1, 2014 and June 30, 2018 were identified using the Maryland Cardiac Surgery Quality Initiative (MCSQI) database. Patient demographics, comorbidities, surgery details, and outcomes were compared between hospitals. We also explored the impact of arterial cannulation site and brain protection technique on outcome. Results A total of 233 patients were included from eight hospitals during the study period. Seventy-six percent of surgeries were done in two high-volume hospitals (≥10 cases per year), while the remaining 24% were done in low-volume hospitals. Operative mortality was 12.0% and varied between 0 and 25.0% depending on the hospital. Variables that differed significantly between hospitals included patient age, the percentage of patients in shock, left ventricular ejection fraction, creatinine level, arterial cannulation site, brain protection technique, tobacco use, and intraoperative blood transfusion. The percentage of patients who underwent aortic valve repair or replacement procedures differed significantly between hospitals (p < 0.001), although the prevalence of moderate-to-severe aortic insufficiency was not significantly different (p = 0.14). There were no significant differences in clinical outcomes including mortality, renal failure, stroke, or gastrointestinal complications between hospitals or based on arterial cannulation site (all p > 0.05). Patients who had aortic cross-clamping or endovascualr repair had more embolic strokes when compared with patients who had hypothermic circulatory arrest (p = 0.03). Conclusion There remains considerable practice variation in Stanford Type A aortic dissection repair surgery within Maryland including some modifiable factors such as intraoperative blood transfusion, arterial cannulation site, and brain protection technique. Continued efforts are needed within MCSQI and nationally to evaluate and employ the best practices for patients having acute aortic dissection repair surgery.

show abstract

“…Many of the variables that were found to be predictive in these models have previously been recognized as high risk factors in separate analysis. (13–15) Rather than trying to combine a multiplicity of factors by using a weighted summation, Bayesian models provide a dynamic incorporation of many variables, yielding a more robust ROC value than previously published scores. (6, 11) The 90-day and 1-year HMRS stratifications had AUC of 61% and 59%, respectively, whereas the Bayesian 90-day and 1-year predictions exhibited AUC of 71% and 70%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…An example of a non-patient related variable would be the number of LVAD implants performed at a site annually, which has been shown to impact patient outcomes. (13) The final BN models included both non-modifiable/historical variables (such as patient age and surgical intervention history) and modifiable variables (such as nutritional assessment, renal function etc.). We recognize that long-term mortality post LVAD implantation is likely more influenced by post-operative adverse events (such as stroke, infections, right ventricular failure etc.)…”

Section: Discussionmentioning

confidence: 99%

A Bayesian Model to Predict Survival After Left Ventricular Assist Device Implantation

Kanwar

Lohmueller

Kormos

et al. 2018

JACC: Heart Failure

View full text Add to dashboard Cite

show abstract

Impact of Center Left Ventricular Assist Device Volume on Outcomes After Implantation

Abstract: Center volume correlates with post-VAD survival, with worse survival noted at very-low volume centers. These findings suggest that current U.S. VAD center standards warrant reconsideration.

Cited by 57 publications

References 18 publications

Variability in clinical decision‐making for ventricular assist device implantation in pediatrics

Variability in clinical decision‐making for ventricular assist device implantation in pediatrics

Clinical Practice Variation and Outcomes for Stanford Type A Aortic Dissection Repair Surgery in Maryland: Report from a Statewide Quality Initiative

A Bayesian Model to Predict Survival After Left Ventricular Assist Device Implantation

Contact Info

Product

Resources

About