Clinical characteristics and outcomes of patients requiring prolonged inotropes after left ventricular assist device implantation

Abstract

Limited data exist regarding patients with continuous‐flow left ventricular assist device (LVAD) support who require long‐term inotropes. Our primary objective was to evaluate the clinical characteristics and all‐cause mortality of LVAD recipients with prolonged inotrope use (PIU). Secondary endpoints were to compare predictors of PIU, mortality, risk of late re‐initiation of inotropes, time to gastrointestinal bleed (GIB), infection, and arrhythmias. Retrospective cohort study was conducted on adult patients with primary continuous‐flow LVADs implanted from January 2008 to February 2017 and the patients were followed up through February 2018. We defined PIU as ≥14 days of inotrope support. Kaplan–Meier method, competing risk models and Cox proportional hazard models were used. Final analytic sample was 203 patients, 58% required PIU, and 10% were discharged on inotropes. There was no difference in preimplant characteristics. One‐year survival rate was 87% if no PIU required, 74% if PIU required, and 72% if discharged on inotropes. PIU was associated with longer length of stay and higher incidence of GIB. We found no association between PIU and late re‐initiation of inotropes, infection or arrhythmias. Adjusted hazard risk of death was increased in patients with PIU (HR = 1.66, P = .046), older age (HR = 1.28, P = .031), and higher creatinine levels (HR = 1.60, P = .007). Prolonged inotrope use is frequently encountered following LVAD implantation and is associated with adverse prognosis but remains a therapeutic option. Inability to wean inotropes prior to hospital discharge is a marker of patients at particularly higher risk of mortality following LVAD implantation.

Prediction, prevention, and management of right ventricular failure after left ventricular assist device implantation: A comprehensive review

“…INTERMACS grades RVF severity according to the duration of required therapy [mainly nitric oxide (iNO) and inotropes] with 0–7 days of support defined as mild RVF, 7–14 days considered moderate RVF, and >14 days or need for RVAD was defined as severe RVF ( 5 ). Subsequent studies have demonstrated that only severe, INTERMACS-defined RVF is associated with worse outcomes ( 6 , 7 ). Thus, it seems reasonable to consider a clinically relevant episode of RVF as only those episodes that require RVAD or inotropic support for >14 days, acknowledging that prognosis worsens with duration ( 8 , 9 ).…”