Gender differences and outcomes in left ventricular assist device support: The European Registry for Patients with Mechanical Circulatory Support

Magnussen, Christina; Bernhardt, A.; Ojeda, Francisco; Wagner, Florian; Gummert, Jan; By, Theo M M H de; Krabatsch, Thomas; Mohaçsi, Paul; Rybczynski, Meike; Knappe, Dorit; Sill, B.; Deuse, T.; Blankenberg, Stefan; Schnabel, Renate B.; Reichenspurner, Hermann

doi:10.1016/j.healun.2017.06.016

Cited by 96 publications

(113 citation statements)

References 22 publications

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“…Data from large US and European LVAD registries confirm that women have a higher risk of early mortality after LVAD implantation and experience higher rates of adverse events including major bleeding, right ventricular failure, and stroke. 4,32,33 Survival was similar for men and women post-LVAD in our cohort. However, it is important for future clinical trials to capture the diversity of "real-world" LVAD experience, such that shared decision making surrounding advanced HF therapies can accurately inform female LVAD candidates about their risk for adverse events after implant.…”

Section: Discussionmentioning

confidence: 51%

Sex differences in eligibility for advanced heart failure therapies

Steinberg

Nayak

O'Connell

et al. 2020

Clinical Transplantation

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Objectives:We investigated sex-based differences in eligibility for and outcomes after receipt of advanced heart failure (HF) therapies.Background: Although women are more likely to die from HF than men, registry data suggest that women are less likely to receive heart transplant (HT) or left ventricular assist device (LVAD) for largely unknown reasons. Methods:We performed a single-center retrospective cohort study of patients evaluated for advanced HF therapies from 2012 to 2016. Logistic regression was used to determine the association of sex with eligibility for HT/LVAD. Competing risks and Kaplan-Meier analysis were used to examine survival. Results:Of 569 patients (31% women) evaluated, 223 (39.2%) were listed for HT and 81 (14.2%) received destination (DT) LVAD. Women were less likely to be listed for HT (adjusted odds ratio [OR] 0.36, 95% confidence interval [CI] 0.21-0.61; P < .0001), based on allosensitization (P < .0001) and obesity (P = .02). Women were more likely to receive DT LVAD (adjusted OR 2.29, 95% CI 1.23-4.29; P = .01). Survival was similar between men and women regardless of whether they received HT and DT LVAD or were ineligible for therapy. Conclusion:Women are less likely to be HT candidates, but more likely to receive DT LVAD. K E Y W O R D Sdisparities, heart failure, heart transplant, left ventricular assist device, women

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Section: Discussionmentioning

confidence: 51%

Sex differences in eligibility for advanced heart failure therapies

Steinberg

Nayak

O'Connell

et al. 2020

Clinical Transplantation

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“…Also risk stratification before cf-LVAD implantation in individual patients is essential. Presently we are only on the verge of acquiring this knowledge [26,27]. The assessment of a personal risk model could improve individualised therapy, for example the anticoagulation regimen, which is now generally the same for each type of device and for every patient.…”

Section: Resultsmentioning

confidence: 99%

Outcome of mechanical circulatory support at the University Medical Centre Utrecht

et al. 2020

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Background The prevalence of heart failure (HF) is increasing substantially and, despite improvements in medical therapy, HF still carries a poor prognosis. Mechanical circulatory support (MCS) by a continuousflow left ventricular assist device (cf-LVAD) improves survival and quality of life in selected patients. This holds especially for the short-term outcome, but experience regarding long-term outcome is growing as the waiting time for heart transplantation is increasing due to the shortage of donor hearts. Here we present our results from the University Medical Centre Utrecht. Methods Data of all patients with a cf-LVAD implant between March 2006 and January 2018 were collected. The primary outcome was survival. Secondary outcomes included adverse events defined according to the Interagency Registry for Mechanically Assisted Cir-Electronic supplementary material The online version of this article (

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“…Recently published studies investigating the impact of gender on outcome after LVAD implantation showed divergent results: Whereas women and men differed in perioperative hemodynamics, adverse events, and mortality after VAD implantation in some trials, others could not find any significant differences in survival or complications while on LVAD support …”

Section: Discussionmentioning

confidence: 99%

Prediction of acute kidney injury after left ventricular assist device implantation: Evaluation of clinical risk scores

et al. 2019

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Acute kidney injury (AKI) is frequent in patients scheduled for implantation of a left ventricular assist device (LVAD) and associated with increased mortality. Although several risk models for the prediction of postoperative renal replacement therapy (RRT) have been developed for cardiothoracic patients, none of these scoring systems have been validated in LVAD patients. A retrospective, single center analysis of all patients undergoing LVAD implantation between September 2013 and July 2016 was performed. Primary outcome was AKI requiring RRT within 14 days after surgery. The predictive capacity of the Cleveland Clinic Score (CCS), the Society of Thoracic Surgeons Score (STS), and the Simplified Renal Index Score (SRI) were evaluated. 76 patients underwent LVAD implantation, 19 patients were excluded due to preoperative RRT. RRT was associated with a prolonged ventilation time, length of stay on the ICU and 180 day mortality (14(60.9%) vs 6(17.6%), P < .01).Whereas the Thakar Score (7.43 ± 1.75 vs 6.44 ± 1.44, P = .02) and the Mehta Score (28.12 ± 15.08 vs 21.53 ± 5.43, P = .02) were significantly higher in patients with RRT than in those without RRT, the SRI did not differ between these groups (3.96 ± 1.15 vs 3.44 ± 1.05, P = .08). Using ROC analyses, CCS, STS, and SRI showed moderate predictive capacity for RRT with an AUC of 0.661 ± 0.073 (P = .040), 0.637 ± 0.079 (P = .792), and 0.618 ± 0.075 (P = .764), respectively, with comparable accuracy in the Delong test. Using univariate logistic regression analysis, only the De Ritis Ratio (OR 2.67, P = .034) and MELD (OR 1.11, P = .028) were identified as predictors of postoperative RRT. Risk scores which are predictive in general cardiac surgery cannot predict RRT in patients after LVAD implantation. Therefore, it seems to be necessary to develop a specific risk score for this patient population. K E Y W O R D Sacute kidney injury, left ventricular assist device, renal replacement therapy | 163 PILARCZYK et AL.

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Gender differences and outcomes in left ventricular assist device support: The European Registry for Patients with Mechanical Circulatory Support

Cited by 96 publications

References 22 publications

Sex differences in eligibility for advanced heart failure therapies

Sex differences in eligibility for advanced heart failure therapies

Outcome of mechanical circulatory support at the University Medical Centre Utrecht

Prediction of acute kidney injury after left ventricular assist device implantation: Evaluation of clinical risk scores

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