Vascular complications associated with percutaneous left ventricular assist device placement: A 10‐year US perspective

Abstract

Background: Over the last decade, there has been a significant increase in the use of percutaneous left ventricular assist devices(p-LVADs). p-LVADs are being increasingly used during complex coronary interventions and for acute cardiogenic shock.These large bore percutaneous devices have a higher risk of vascular complications.We examined the vascular complication rates from the use of p-LVAD in a national database.Methods: We conducted a secondary analysis of the National In-patient Sample (NIS) dataset from 2005 till 2015. We used the ICD-9-CM procedure codes 37.68 and 37.62 for p-LVAD placement regardless of indications. We investigated common vascular complications, defining them by the validated ICD 9 CM codes. χ 2 test and t test were used for categorical and continuous variables, respectively for comparison.Results: A total of 31,263 p-LVAD placements were identified during the period studied. A majority of patients were male (72.68%) and 64.44% were white. The overall incidence of vascular complications was 13.53%, out of which 56% required surgical treatment. Acute limb thromboembolism and bleeding requiring transfusion accounted for 27.6% and 21.8% of all vascular complications. Occurrence of a vascular complication was associated with significantly higher in-hospital mortality (37.77% vs. 29.95%, p < .001), length of stay (22.7 vs. 12.2 days, p < .001) and cost of hospitalization ($ 161,923 vs. $ 95,547, p < .001).Conclusions: There is a high incidence of vascular complications with p-LVAD placement including need for vascular surgery. These complications are associated with a higher in-hospital, LOS and hospitalization costs. These findings should be factored into the decision-making for p-LVAD placement.

Complications from percutaneous-left ventricular assist devices versus intra-aortic balloon pump in acute myocardial infarction-cardiogenic shock

“…This is one of the largest studies to holistically review and discuss complications of pLVAD and IABP use in AMI-CS. Prior studies from the HCUP-NIS database have discussed individual complications specifically, but have not investigated the broad categories of clinically relevant complications that are reviewed in the present study [37,40,41]. Our results are consistent with prior work demonstrating that pLVAD has a higher overall complication rate when compared to IABP [6,20,22,23,42].…”

“…Similar to prior literature, we identified relevant complications and categorized them as–(a) vascular complications–arterial injury, acquired arterio-venous fistula, vascular complications requiring surgery; (b) lower limb amputation; (c) hematologic–post-operative hemorrhage, hemolytic anemia, thrombocytopenia, blood transfusion; (d) neurologic–ischemic or hemorrhagic stroke; and (e) acute kidney injury (AKI) ( S1 Table ) [ 7 , 33 – 36 ]. We did not include critical limb ischemia under vascular complications since there is no reliable way to distinguish acute from chronic limb ischemia using administrative codes [ 37 , 38 ]. The primary outcome was the rates of complications in admissions receiving pLVAD compared to the IABP.…”

SCAI position statement on optimal percutaneous coronary interventional therapy for complex coronary artery disease

“… 39,40 Heart team management decisions should also weigh the relative risks and benefits of both MCS‐assisted and unassisted PCI compared with available surgical therapeutic options including surgical revascularization, durable LV assist device implantation, and heart transplantation. Appropriate patient selection is particularly critical in light of the potential for device‐related complications 44‐46 …”

The Role of Hemodynamic Support in High-risk Percutaneous Coronary Intervention

“…Despite the ability for optimization of hemodynamics, the risks associated with the large-bore access for all these mechanical support devices include bleeding and vascular complications. [18][19][20][21][22]…”