2186KATO NP et al. Circulation JournalOfficial Journal of the Japanese Circulation Society http://www. j-circ.or.jpMeanwhile, there are no studies evaluating the difference in QOL between implantable and extracorporeal LVAD patients. The 2 types of LVADs provide similar results in terms of systemic circulation assist and cardiac unloading effect, but the effect on patients' QOL may differ.It is important to understand the factors associated with patients' QOL in order to outline management strategies for LVAD patients that do not only focus on objective goals, but also on the patients' perceptions. Prior studies have shown limited associations between psychological distress and QOL, 1,7 suggesting that factors other than psychological problems may be important in determining QOL after LVAD implantation.The purpose of the present study was (1) to evaluate the effect of an having an implantable LVAD on patients' QOL, eft ventricular assist device (LVAD) therapy is expected to be increasingly indicated as a bridge to transplant or/and destination therapy. However, studies focusing on the effect of LVAD therapy on patients' quality of life (QOL) are limited. 1-3 In Japan, the number of LVAD patients has been increasing since implantation became covered by health insurance in 2011. It is important to know the effect of LVAD therapy from the patients' perspective.Comparison of the QOL of patients with an implantable LVAD and those in different stages of heart failure (HF) might help healthcare professionals to understand how much improvement in QOL can be expected from implantable LVADs. Several studies have shown that implantable LVAD patients have a better QOL than heart transplantation (HTx) patients. Minoru Ono, MD, PhD; Tiny Jaarsma, PhD; Koichiro Kinugawa, MD, PhDBackground: Improving quality of life (QOL) has become an important goal in left ventricular assist device (LVAD) therapy. We aimed (1) to assess the effect of an implantable LVAD on patients' QOL, (2) to compare LVAD patients' QOL to that of patients in different stages of heart failure (HF), and (3) to identify factors associated with patients' QOL.

Aims We assessed preoperative muscle wasting in patients undergoing left ventricular assist device (LVAD) implantations using abdominal skeletal muscle images on computed tomography (CT) and explored the associations between the preoperative muscle wasting and clinical outcomes after LVAD implantation. Methods and results We retrospectively examined the records of 111 patients who underwent continuous‐flow LVAD implantations as bridge‐to‐transplant therapy from January 2010 to December 2016 at our institution. After 33 patients were excluded, the study cohort consisted of 78 individuals. CT images used to calculate the skeletal muscle index (SMI) at the third lumbar vertebra level were obtained before the LVAD implantation procedures. Patients were classified as having muscle wasting if their SMI fell into the lowest gender‐based tertile. The median SMI for the study patients was 37.6 cm 2 /m 2 . The SMI cut‐off values for the lowest tertiles were 36.7 cm 2 /m 2 for men and 28.2 cm 2 /m 2 for women, resulting in 26 patients (33.3%) with muscle wasting in this study. During the mean follow‐up of 738 ± 379 days, there were 10 deaths (12.8% mortality). Seven of the 26 patients with muscle wasting (26.9%) died, and 3 of the 52 patients without muscle wasting (5.8%) died. The times to all‐cause mortality were significantly different between patients with and without muscle wasting ( P = 0.0094). Muscle wasting was found to be associated with mortality in univariate and multivariate Cox analyses (hazard ratio: 4.32; 95% CI: 1.19–20.2). Conclusions Preoperative muscle wasting was associated with a higher mortality in patients with LVAD. Assessment of the abdominal skeletal muscle area on CT prior to LVAD implantation can help predict mortality.

Survival in patients with continuous flow left ventricular assist device (CF LVAD) had been increased owing to improved perioperative management procedures. The second target for successful long-term LVAD treatment was to reduce readmission especially due to device-specific infection, which was one of the major unsolved complications. Among 57 enrolled patients who had received CF LVAD and been followed for 530 days on median at our institute between 2008 and 2014, 21 patients experienced readmission due to driveline infection (DLI) at 190 days after the surgery on median. Considering the result of Uni/Multivariate Cox regression analyses demonstrating lower serum albumin concentration (S-ALB) (hazard ratio 0.144) and body mass index (BMI) (hazard ratio 0.843) both obtained at discharge were independent predictors of readmission due to DLI, we constructed a New Score "7 × [S-ALB (g/dL)] + [BMI]", which significantly stratified readmission-free rate into 3 groups [low (>50 Pt), intermediate (44-50 Pt), and high risk group (<44 Pt)] during 2-year study period (p = 0.008). Survival remained unchanged irrespective of DLI, whereas those with DLI needed longer in-hospital treatment (p < 0.05). In conclusion, readmission due to DLI could be predicted by using two simple nutrition parameters at discharge. Early nutrition assessment and intervention may reduce readmission and improve patients' quality of life during long-term LVAD support.

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