Readmissions After Ventricular Assist Device: Etiologies, Patterns, and Days Out of Hospital

Bello, Ricardo; Friedmann, Patricia; Casazza, D.; Nucci, C.; Shin, J.; D’Alessandro, David A.; Stevens, Gerin R.; Goldstein, Daniel J.

doi:10.1016/j.athoracsur.2012.12.039

Cited by 104 publications

(74 citation statements)

References 13 publications

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“…Readmissions in the general LVAD population have implicated bleeding, cardiac anomalies and infections as the major causative reasons, in order of prevalence. [16][17][18][19] In contrast, reasons for 30-day readmissions were somewhat different, with recurrent HF taking the lead, followed by gastrointestinal bleeding. 22 Long-term LVAD support predisposes patients to readmissions due to infections as opposed to bleeding events.…”

Section: Discussionmentioning

confidence: 92%

“…10,[16][17][18][19]21 The limited literature examining postoperative LOS in the LVAD population varies widely, ranging from 17 days to 25 days. 16,18 Compared with other centres, our centre leans toward having increased length of postoperative stays. At present in our centre, patients are discharged directly home after LVAD implantation, contrary to other institutions where (18) 38% (14) 13% (5) 4 years 43% (16) 41% (15) 16% (6) patients are transferred to rehabilitation centres before discharge home.…”

Section: Discussionmentioning

confidence: 99%

“…Our survival rates of 77% at 1 year and 74% at 2 years are comparable to those in the large INTERMACS registry as well as those of several smaller centre analyses. 10,[16][17][18] Increasing experience with device implantation and optimal clinical management of patients has led to improved outcomes in patients with LVADs. The first HMII trial reported a survival of 68%, 3 which has now improved to 85%.…”

Section: Discussionmentioning

confidence: 99%

“…Previously described complications post-LVAD leading to readmissions include gastrointestinal and cerebrovascular bleeding events, infections and thromboembolism. [16][17][18][19] Unfortunately, although the proportion of patients with LVADs supported for more than 1 year is increasing, the literature exploring clinical outcomes, readmissions and procedures during prolonged LVAD support remains scarce. The goal of the present study is to report on clinical outcomes of patients supported for more than 1 year on a CF-LVAD.…”

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confidence: 99%

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Long-term use of left ventricular assist devices: a report on clinical outcomes

Raju

MacIver

Foroutan

et al. 2017

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Background:The literature examining clinical outcomes and readmissions during extended (> 1 yr) left ventricular assist device (LVAD) support is scarce, particularly in the era of continuous-flow LVADs. Methods:We completed a retrospective cohort study on consecutive LVAD patients from June 2006 to March 2015, focusing on those who received more than 1 year of total LVAD support time. Demographic characteristics, clinical outcomes and readmissions were analyzed using standard statistical methods. All readmissions were categorized as per the Interagency Registry for Mechanically Assisted Circulatory Support 2015 guidelines. Results:Of the 103 patients who received LVADs during the study period, 37 received LVAD support for more than 1 year, with 18 receiving support for more than 2 years. Average support time was 786 ± 381 days, with total support time reaching 80 patient-years. During a median follow-up of 2 years, 27 patients died, with 1-year conditional survival of 74%. Median freedom from first readmission was 106 days (range 1-603 d), with an average length of stay of 6 days. Readmissions resulted in an average of 41 ± 76 days in hospital per patient. Reasons for readmission were major infection (24%), major bleeding (19%) and device malfunction/thrombus (13%). There were a total of 112 procedures completed during the readmissions, with 60% of procedures being done in 13% (n = 5) of patients. Conclusion:Continuous-flow LVADs provide excellent long-term survival. The present study describes marked differences in reasons for readmissions between the general LVAD population and those supported for more than 1 year. Prolonged LVAD support resulted in decreased susceptibility to major bleeds and increased susceptibility to infection. Résultats :Parmi les 103 patients chez qui un DAVG a été implanté durant la période de l'étude, 37 en ont bénéficié pendant plus d'un an et 18 pendant plus de 2 ans. La durée moyenne d'utilisation a été de 786 ± 381 jours, la durée totale de l'assistance ainsi fournie atteignant 80 années-patients. Pendant la période de suivi médiane de 2 ans, 27 patients sont décédés, ce qui correspond à une survie conditionnelle d'un an chez 74 % des participants. L'intervalle médian avant une première réadmission a été de 106 jours (éventail 1-603 jours), et la durée médiane des séjours a été de 6 jours. Les réadmissions ont en moyenne été suivies d'un séjour hospitalier de 41 ± 76 jours par patient. Les raisons des réadmissions ont été infection grave (24 %), hémorragie majeure (19 %) et dysfonction du dispositif/thrombus (13 %). En tout, 112 interventions ont été effectuées lors des réadmissions, 60 % d'entre elles chez 13 % des patients (n = 5). Conclusion :Les DAVG à flux continu donnent lieu à une excellente survie à long terme. La présente étude décrit les différences marquées en ce qui concerne les raisons des réad-missions entre la population générale porteuse d'un DAVG et la population ayant bénéficié du dispositif pendant plus d'un an. Le recours prolongé à un DAVG a été associé à une ...

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Long-term use of left ventricular assist devices: a report on clinical outcomes

Raju

MacIver

Foroutan

et al. 2017

cjs

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“…However, complications such as bleeding, infections, strokes and pump thrombosis result in multiple readmissions and continue to plague this therapy. Single-center studies have reported readmission rates of 1.5-2.5 per patient-year, with the majority occurring during the first 6 months after implantation (30,31). The associated costs from these events are proving to be a significant financial burden on the health care industry.…”

Section: Mechanical Circulatory Support (Mcs)mentioning

confidence: 99%

The future of cardiac transplantation

Koomalsingh¹,

Kobashigawa²

2018

Ann. Cardiothorac. Surg.

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The first human-to-human heart transplant was performed 50 years ago in 1967. Heart transplantation has now entered an era of tremendous growth and innovation. The future of heart transplantation is bright with the advent of newer immunosuppressive medications and strategies that may even result in tolerance.Much of this progress in heart transplant medicine is predicated on a better understanding of acute and chronic rejection pathways through basic science studies. The future will also include personalized medicine where genomics and molecular science will dictate customized treatment for optimal outcomes. The introduction of mechanical circulatory support (MCS) devices has changed the landscape for patients with severe heart failure to stabilize the most ill patient and make them better candidates for heart transplant.As ex vivo preservation takes hold, we may witness an expansion of the donor pool through the use of donation after cardiac death (DCD) donors. In addition, further geographical donor heart sharing through ex vivo preservation may further decrease waitlist mortality by enabling longer distance donor hearts to be allocated for the sickest waitlist patient. It is no doubt an exciting time to be involved in the field of heart transplantation. In this perspective, we will summarize the present state of heart transplantation and discuss various innovations that are being pursued.

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