Severity of End-Organ Damage as a Predictor of Outcomes After Implantation of Left Ventricular Assist Device

Abstract

The optimal timing of left ventricular assist device (LVAD) implantation in the management of advanced heart failure remains controversial. We hypothesize that in patients with cardiogenic shock, the severity of end-organ dysfunction as determined by the sequential organ failure assessment (SOFA) score is a determinant of outcomes after LVAD implantation. We determined the preoperative SOFA score and short- and long-term outcomes of 97 consecutive patients who received HeartMate II or HeartWare LVAD at our institution since January 2007. Kaplan-Meier analysis was used to compare long-term survival across SOFA score subgroups. The overall 30 day mortality was 10.1%, with no significant difference among SOFA score subgroups. Patients with scores ≥9 had significantly longer hospital stay (26 ± 6 vs. 18 ± 10 days, p = 0.03). One-year survival for SOFA scores 0-2, 3-5, 6-8, and ≥9 was 94%, 75%, 64%, and 29%, respectively. SOFA score was significantly lower in survivors at 6, 9, 12, 24, and 36 months. SOFA score did not predict adverse outcomes of bleeding, cerebrovascular events, infection, or pump exchange. These results show that preoperative SOFA score is a powerful predictor of outcomes after LVAD implantation. Long-term outcomes can be significantly improved by early intervention before emergence of end-organ dysfunction.

Outcome of Temporary Circulatory Support As a Bridge-to-Left Ventricular Assist Device Strategy in Cardiogenic Shock Patients

“…Short-term mortality rates for cardiogenic shock patients implanted with a LVAD range from 10% to 24% (9, 14, 22), which is coherent with our results, with a 16.6% total mortality in the cardiogenic shock group at 30 days. Additionally, despite nonsignificant, 30 days mortality rate was numerically higher in the BTL group compared with the non-BTL group (21.4% vs 11.9%).…”

Sequential organ failure assessment score improves survival prediction for left ventricular assist device recipients in intensive care

“…Although the SOFA score was originally developed and most widely studied for patients with sepsis, 24 it has been evaluated in a variety of clinical environments, including combined medical‐surgical units, 25 liver transplantation units, 26 obstetrical ICUs, 27 coronary care units, 28 and cardiac surgery ICUs 29 . Landis and colleagues 30 reported that after LVAD implantation, preoperative SOFA scores did not predict 30‐day mortality (AUC = 0.67), as well as, they predicted intermediate‐term outcomes at 3, 6, 9, and 12 months (AUC = 0.72). Better predictive accuracy has been noted with postoperative SOFA score derivations such as maximum 31,32 and mean SOFA scores 33 after cardiac surgery.…”

Anesthesia for left ventricular assisted device insertion in a patient with multiple organ failure

“…Our patient was in MOF with pre-operative SOFA scores predicting a 1-year mortality risk of at least 36%,[ 4 ] Which was not in favor of the placement of LVAD. Furthermore, placement of LVAD itself is associated with 32% chance of developing MOF with a 71% mortality rate for those with MOF.…”