Predictors of in-hospital mortality in patients with left ventricular assist device

Gonuguntla, Karthik; Patil, Shivaraj; Cowden, Richard G.; Kumar, Manish; Rojulpote, Chaitanya; Bhattaru, Abhijit; Tiu, John; Robinson, P. A.

doi:10.1007/s11845-020-02246-y

Cited by 5 publications

(6 citation statements)

References 30 publications

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“…Of these, 215 articles were excluded resulting in 154 studies that met the selection criteria. We excluded 25 studies with no usable data: 23 did not report baseline risk for mortality by BMI group, 17‐39 1 only reported a p value, 40 and another 1 mentioned data in a supplement that were not available 41 . Disagreements about the inclusion of studies occurred in 16% of the articles ( kappa = 0·67).…”

Section: Resultsmentioning

confidence: 99%

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

2023

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SummaryFasting insulin and c‐reactive protein confound the association between mortality and body mass index. An increase in fat mass may mediate the associations between hyperinsulinemia, hyperinflammation, and mortality. The objective of this study was to describe the “average” associations between body mass index and the risk of mortality and to explore how adjusting for fasting insulin and markers of inflammation might modify the association of BMI with mortality. MEDLINE and EMBASE were searched for studies published in 2020. Studies with adult participants where BMI and vital status was assessed were included. BMI was required to be categorized into groups or parametrized as non‐first order polynomials or splines. All‐cause mortality was regressed against mean BMI squared within seven broad clinical populations. Study was modeled as a random intercept. β coefficients and 95% confidence intervals are reported along with estimates of mortality risk by BMIs of 20, 30, and 40 kg/m2. Bubble plots with regression lines are drawn, showing the associations between mortality and BMI. Splines results were summarized. There were 154 included studies with 6,685,979 participants. Only five (3.2%) studies adjusted for a marker of inflammation, and no studies adjusted for fasting insulin. There were significant associations between higher BMIs and lower mortality risk in cardiovascular (unadjusted β −0.829 [95% CI −1.313, −0.345] and adjusted β −0.746 [95% CI −1.471, −0.021]), Covid‐19 (unadjusted β −0.333 [95% CI −0.650, −0.015]), critically ill (adjusted β −0.550 [95% CI −1.091, −0.010]), and surgical (unadjusted β −0.415 [95% CI −0.824, −0.006]) populations. The associations for general, cancer, and non‐communicable disease populations were not significant. Heterogeneity was very large (I2 ≥ 97%). The role of obesity as a driver of excess mortality should be critically re‐examined, in parallel with increased efforts to determine the harms of hyperinsulinemia and chronic inflammation.

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Section: Resultsmentioning

confidence: 99%

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

2023

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“…With this combination of shared care, teamwork, and standardized management it is possible that individual surgeon volume does not significantly impact patient outcome. Instead, predictors of mortality in our study reiterated those previously described and included patient factors that are surrogates for acuity 2–4,15 …”

Section: Discussionmentioning

confidence: 99%

“…1 Risk factors for mortality and adverse events following left ventricular assist device (LVAD) implantation, including patient factors, device selection, and procedural-related factors, have been studied extensively. [1][2][3][4] However, while a variety of studies have demonstrated a relationship between surgical volume and mortality in the field of cardiac surgery there remains a paucity of data regarding the relationship between surgeon volume and outcomes following LVAD implantation. [5][6][7] A relationship between institution volume and VAD outcomes has been described in the literature, with studies bearing mixed results.…”

Section: Introductionmentioning

confidence: 99%

“…Ventricular assist devices (VADs) are a widely available treatment option for patients with advanced heart failure, with more than 3100 devices being implanted in the United States in 2019 1 . Risk factors for mortality and adverse events following left ventricular assist device (LVAD) implantation, including patient factors, device selection, and procedural‐related factors, have been studied extensively 1–4 . However, while a variety of studies have demonstrated a relationship between surgical volume and mortality in the field of cardiac surgery there remains a paucity of data regarding the relationship between surgeon volume and outcomes following LVAD implantation 5–7 …”

Section: Introductionmentioning

confidence: 99%

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In a large‐volume multidisciplinary setting individual surgeon volume does not impact LVAD outcomes

Boudreaux

Urban

Castleberry

et al. 2022

Journal of Cardiac Surgery

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Background: In complex operations surgeon volume may impact outcomes. We sought to understand if individual surgeon volume affects left ventricular assist device (LVAD) outcomes. Methods:We reviewed primary LVAD implants at an experienced ventricular assist devices (VAD)/transplant center between 2013 and 2019. Cases were dichotomized into a high-volume group (surgeons averaging 11 or more LVAD cases per year), and a low-volume group (10 or less per year). Propensity score matching was performed.Survival to discharge, 1-year survival, and incidence of major adverse events were compared between the low-and high-volume groups. Predictors of survival were identified with multivariate analysis.Results: There were 315 patients who met inclusion criteria-45 in the low-volume group, 270 in the high-volume group. There was no difference in survival to hospital discharge between the low (91.9%) and high (83.3%) volume matched groups (p = .22). Survival at 1-year was also similar (85.4% vs. 80.6%, p = .55). There was no difference in the incidence of major adverse events between the groups. Predictors of mortality in the first year included: age (hazards ratio [HR]: 1.061, p < .001), prior sternotomy (HR: 1.991, p = .01), increasing international normalized ratio (HR: 4.748, p < .001), increasing AST (HR: 1.001, p < .001), increasing bilirubin (HR: 1.081, p = .01), and preoperative mechanical ventilation (HR: 2.662, p = .005). Individual surgeon volume was not an independent predictor of discharge or 1-year survival. Conclusion:There was no difference in survival or adverse events between high and low volume surgeons suggesting that, in an experienced multidisciplinary setting, low-volume VAD surgeons can achieve similar outcomes to their high-volume colleagues.

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“…In the pre-allocation era, predictors of in-hospital mortality for LVAD implantation included age, hemodialysis, cerebrovascular disease, mechanical ventilation, liver disease, acute kidney injury (AKI), disseminated intravascular coagulation, sepsis, septic shock, and gastrointestinal bleeding [ 7 ]. However, HeartMate 3 (HM3; Abbott Cardiovascular, Chicago, IL, USA) has reduced complications, such as thrombosis and stroke events [ 8 ], and is the majority in the post-allocation era (47.3% versus 8.3%) [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Age Is a Predictor of In-Hospital Outcomes for Left Ventricular Assist Device Implantation: A Nationwide Analysis

Akkawi,

Yamaguchi,

Shimamura

et al. 2024

JPM

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The 2018 heart allocation system has significantly influenced heart transplantation and left ventricular assist device (LVAD) utilization. Our study aims to investigate age-related outcomes following LVAD implantation in the post-allocation era. Using the National Inpatient Sample, we analyzed data from 7375 patients who underwent LVAD implantation between 2019 and 2020. The primary endpoint was in-hospital mortality following LVAD implantation, stratified by age categories. The age groups were 18–49, 50–59, 60–69, and over 70. These represented 26%, 26%, 31%, and 17% of patients, respectively. Patients aged 60–69 and those over 70 exhibited higher in-hospital mortality rates of 12% and 17%, respectively, compared to younger age groups (7% for 18–49 and 6% for 50–59). The age groups 60–69 and over 70 were independent predictors of mortality, with adjusted odds ratios of 1.99 (p = 0.02; 95% confidence interval [CI], 1.12–3.57) and 2.88 (p = 0.002; 95% CI, 1.45–5.71), respectively. Additionally, a higher Charlson Comorbidity Index was associated with increased in-hospital mortality risk (adjusted odds ratio 1.39; p = 0.02; 95% CI, 1.05–1.84). Additionally, patients above 70 experienced a statistically shorter length of stay. Nonhome discharge was found to be significantly high across all age categories. However, the difference in hospitalization cost was not statistically significant across the age groups. Our study highlights that patients aged 60 and above face an increased risk of in-hospital mortality following LVAD implantation in the post-allocation era. This study sheds light on age-related outcomes and emphasizes the importance of considering age in LVAD patient selection and management strategies.

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Predictors of in-hospital mortality in patients with left ventricular assist device

Cited by 5 publications

References 30 publications

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

In a large‐volume multidisciplinary setting individual surgeon volume does not impact LVAD outcomes

Age Is a Predictor of In-Hospital Outcomes for Left Ventricular Assist Device Implantation: A Nationwide Analysis

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