Predictors of survival in patients bridged to transplantation with the Thoratec VAD device: a single-center retrospective study on more than 100 patients

El‐Banayosy, Aly; Arusoglu, Latif; Kizner, L.; Tenderich, Gero; Boethig, Dietmar; Minami, Kazutomo; Körfer, Reiner

doi:10.1016/s1053-2498(00)00174-1

Cited by 67 publications

(35 citation statements)

References 8 publications

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“…Overall survival to transplantation or weaning in our patient population was similar to that reported by other groups using the same device [8][9][10][11] or to published registry data [12]. Most of the deaths in our series occurred early after implantation and before ICU dismissal, and were related to MODS.…”

Section: Discussionsupporting

confidence: 87%

Impact of preoperative hemodynamic support on early outcome in patients assisted with paracorporeal Thoratec® ventricular assist device

Kirsch

Vermès

Radu

et al. 2008

European Journal of Cardio-Thoracic Surgery

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Background: Mechanical circulatory support has become a well-established procedure for some patients with cardiogenic shock. However, patient selection and timing of implantation remains critical. This retrospective study was undertaken to identify preoperative predictors of survival in ICU of patients requiring mechanical circulatory support. Methods: Between 1996 and 2006, 71 patients (61 men, 10 women, aged 41.6 AE 12.2 years) with primary cardiogenic shock were assisted using the paracorporeal Thoratec W VAD. Twenty-seven (38%) patients needed preoperative mechanical ventilation. Preoperative IV hemodynamic drug support included dobutamine in 63 (89%), vasopressors (adrenaline, noradrenaline or dopamine !5 mg/kg min) in 47 (66%), and intraaortic balloon counter-pulsation in 22 (31%) patients. Mean preoperative blood creatinine and total bilirubin levels were 162.2 AE 72.4 mmol/l and 36.4 AE 53.9 mmol/l, respectively. Results: Fifty-six (79%) patients required biventricular and 15 (21%) left ventricular support. Patients were assisted for a mean duration of 73.1 AE 93.6 days (extremes, 1-480 days). Twenty-five patients (35%) died while on support. Among these, 18 patients (25%) never recovered sufficiently to allow dismissal from ICU, and died after a mean of 15.4 AE 14.3 days. Logistic regression identified preoperative IV adrenaline as sole predictor for ICU death (OR, 5.48; 95% CI,, p = 0.012). Conclusions: The need for preoperative IV adrenaline therapy appeared to be the sole independent risk factor for death in ICU in patients assisted with the Thoratec W paracorporeal VAD. This suggests that, besides hemodynamic and metabolic consequences of cardiogenic shock, preoperative activation of the inflammatory cascade could influence the prognosis of patients undergoing mechanical circulatory support. #

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Section: Discussionsupporting

confidence: 87%

Impact of preoperative hemodynamic support on early outcome in patients assisted with paracorporeal Thoratec® ventricular assist device

Kirsch

Vermès

Radu

et al. 2008

European Journal of Cardio-Thoracic Surgery

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“…17,21,26,27 Previously reported risk factors for mortality in pediatric VAD patients include younger age, congenital heart disease, earlier date of implantation, female sex, and preimplantation liver function. 8,9,14 The use of an LVAD versus a BiVAD has not been found to influence survival in pediatric populations.…”

Section: Discussionmentioning

confidence: 99%

Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS)-Defined Morbidity and Mortality Associated With Pediatric Ventricular Assist Device Support at a Single US Center

Stein

Robbins²,

Sabati³

et al. 2010

Circ: Heart Failure

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Background-The use of ventricular assist devices (VADs) to bridge pediatric patients to heart transplantation has increased dramatically over the last 15 years. In this report, we present the largest US single-center report of pediatric VAD use to date. We present detailed descriptions of morbidity and mortality associated with VAD support, using standard Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) criteria for pediatrics to facilitate the comparison of these results to other studies. Methods and Results-We retrospectively identified 25 patients younger than 18 years with 27 episodes of mechanical circulatory support using VADs as bridge to heart transplantation from January 1998 to December 2007. Survival to transplant for the entire cohort was 74%. The most common major morbidities, as defined by INTERMACS criteria for a pediatric population, were respiratory failure, major localized infections, major bleeding events, hepatic dysfunction, and right heart failure. Major neurological events occurred in 48% of the study population. The median time to the first occurrence of an adverse event was less than 14 days for respiratory failure, right heart failure, major localized infection, and major bleeding. Patients who died before transplantation had significantly more adverse events per day of support than did those who were successfully transplanted. Episodes of major bleeding, tamponade, acute renal failure, respiratory failure, and right heart failure were all associated with increased risk of mortality. Conclusions-INTERMACS criteria can be successfully used to analyze pediatric VAD outcomes. These data serve as a baseline for future studies of VAD support in children and indicate good survival rates but considerable morbidity. (Circ Heart Fail. 2010;3:682-688.)

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“…After many years of experiences with these lifesaving devices, researchers have suggested that appropriate patient selection and device selection are essential for effective use of LVAS. [4][5][6][7] In Japan, however, the special situation of heart transplantation and very limited device availability have made the indication and timing of LVAS implantation somewhat different from other countries. 8 Because of the extremely severe shortage of donor hearts, heart failure patients in Japan have to wait for heart transplantation for approximately 2 years on average with LVAS support.…”

mentioning

confidence: 99%

Risk Factor Analysis of Long-Term Support With Left Ventricular Assist System

Saito

Matsumiya

Sakaguchi

et al. 2010

Circ J

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Background: This study was designed to elucidate the key factors for successful long-term support with a left ventricular assist system (LVAS) in the situation where heart transplantation is rarely available. Methods and Results:From 1992 to 2008, 106 patients underwent 121 LVAS implantations at Osaka University Hospital (Toyobo: 77; Novacor: 18; HeartMate: 14; Jarvik2000: 8; EvaHeart: 2; DuraHeart: 2). Risk factors for infection were early on the former implanted period (odds ratio (OR) 3.30), Toyobo (OR 2.25), mechanical right heart support (OR 2.30) and cardiopulmonary bypass time (OR 1.01). Left atrium as the inflow site was the risk factor for cerebrovascular events (OR 2.84). Older age (OR 1.04) and mechanical right heart support (OR 4.70) were risk factors for mortality. Risk factors for requiring mechanical right heart support were preoperative extracorporeal membranous oxygenation support (OR 5.641), serum total bilirubin (OR 1.11) and serum creatinine (OR 2.46). On the basis of the risk analysis for mortality, patients were divided into 2 subgroups (low and high risk) and the respective cumulative survival at 1 year after LVAS implantation was 75.2% and 25.0%. Conclusions:Appropriate selection of device, patient and the timing of implantation and less invasive operation are important for successful long-term LVAS support. (Circ J 2010; 74: 715 - 722)

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Predictors of survival in patients bridged to transplantation with the Thoratec VAD device: a single-center retrospective study on more than 100 patients

Cited by 67 publications

References 8 publications

Impact of preoperative hemodynamic support on early outcome in patients assisted with paracorporeal Thoratec® ventricular assist device

Impact of preoperative hemodynamic support on early outcome in patients assisted with paracorporeal Thoratec® ventricular assist device

Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS)-Defined Morbidity and Mortality Associated With Pediatric Ventricular Assist Device Support at a Single US Center

Risk Factor Analysis of Long-Term Support With Left Ventricular Assist System

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