Purpose: This study evaluated the impact of early post-operative hyperlactatemia on outcomes after left ventricular assist device (LVAD) implantation. Methods: Adults undergoing contemporary LVAD implantation (Heart-Mate 3 or HeartWare HVAD) between 2009 to 2018 were included. Peak post-operative (within 24-hours) lactate level was analyzed. The cohort was stratified into patients with and without post-op hyperlactatemia, which was defined as peak >3.5 mMol/L. The primary outcome was survival, and secondary outcomes included post-implant adverse events. Subanalysis was performed to evaluate the impact of hours for lactate normalization, define as lactate <2 mMol/L. Multivariable cox regression was used for risk-adjustment. Results: 190 patients were included. 49.5% experienced post-operative hyperlactatemia. Patients with post-operative hyperlactatemia had significantly higher rates of post-implant complications including re-operation, renal failure, and hepatic dysfunction (all, p≤0.05). The post-operative hyperlactatemia group also had significantly higher 90-days and 1-year mortality rates following LVAD implantation (all, p≤0.05) (Table ). In multivariable analysis, post-operative hyperlactatemia (HR 1.69, 95% CI 1.09-2.60, p=0.02) was an independent predictor of overall mortality following LVAD implantation. Increased time for normalization of lactate also adversely impacted risk-adjusted overall mortality following implantation as a continuous variable (HR 1.02, 95% CI 1.01-1.03, p<.001).
Conclusion:This study demonstrates post-operative hyperlactatemia is associated with increased morbidity and mortality following LVAD implantation. Even early post-operative lactate trends within the first 24 postoperative hours appear to have useful role in predicting longitudinal survival following implantation. Careful monitoring of post-operative lactate with measures to normalize levels should be considered in the early care of LVAD patients.
Objectives: The aim of this study was to evaluate the effect of timing for post-interventional CT imaging on the rate of re-intervention and all-cause mortality in patients with endovascular treatment of type B aortic dissections (TBAD).
Material and methods: Data on 70 patients with endovascular repair of aortic dissection during a three-year period from a single institution retrospectively were collected. Study participants were stratified based on those who had a postoperative CTA in the first 30 days after index intervention (early) vs. those who did not (late). The re-intervention and all-cause mortality rates between the two groups were investigated using Kaplan-Meier and Cox regression analysis.
Results: During a median follow-up time of 230 days, the primary endpoint (additional operation) was reached in 24/70 patients (34.3%) with no statistically significant difference between the early and late CTA group (log-rank-test: P = 0.886). All-cause mortality was present in 14/70 (20%) patients, with no statistically significant difference between both groups (log-rank-test: P = 0.440). Additionally, both groups had no significant differences in time to additional operation and death. Cox regression analysis revealed the presence of a chronic TBAD and underlying connective tissue disease as relevant risk factors for the need for an additional operation and obesity as a protective and renal failure as a negative factor for all-cause mortality.
Conclusion: CTA surveillance within 30 days of the index operation did not significantly modify mortality or rate of re-intervention after endovascular treatment for TBAD. Surveillance recommendations should be tailored to individualized factors.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.