Early adverse events as predictors of 1-year mortality during mechanical circulatory support

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:29

Article

Dew, Mary Amanda^1,2,3,4  Teuteberg, Jeffrey J.⁵  Simon, Marc A.⁵  Bhama, Jay K.⁶  Bermudez, Christian A.⁶  Kormos, Robert L.⁶ 

[1] Univ Pittsburgh, Sch Med, Med Ctr, Artificial Heart Program, Pittsburgh, PA 15213 USA

[2] Univ Pittsburgh, Sch Med, Dept Epidemiol, Pittsburgh, PA 15213 USA

[3] Univ Pittsburgh, Sch Med, Dept Biostat, Pittsburgh, PA 15213 USA

[4] Univ Pittsburgh, Sch Med, Dept Psychiat, Pittsburgh, PA 15213 USA

[5] Univ Pittsburgh, Cardiovasc Inst, Pittsburgh, PA 15213 USA

[6] Univ Pittsburgh, Esophageal Surg Inst, Pittsburgh, PA 15213 USA

关键词: mechanical circulatory support;    heart failure;    outcomes;    mortality;   

DOI  :  10.1016/j.healun.2010.04.014

来源: Elsevier

【 摘 要 】

BACKGROUND: Ventricular assist devices (VADs) provide effective treatment for end-stage heart failure; however, most patients experience >= 1 major adverse events (AEs) while on VAD support. Although early, non-fatal AEs may increase the risk of later death during VAD support, this relationship has not been established. Therefore, we sought to determine the impact on 1-year mortality of AEs occurring during the first 60 days of VAD support. METHODS: A retrospective analysis was' performed using prospectively collected data from a single-site database for patients aged >= 18 years receiving left ventricular or biventricular support during 1996 to 2008 and who survived >60 days on VAD support. Fourteen major classes of AEs occurring during this 60-day period were examined. One-year survival rates of patients with and without each major AE were compared. RESULTS: The study included 163 patients (80% men; mean age, 49.5 years), of whom 87% were European American, 72% had left ventricular support, and 83% were bridge to transplant. The occurrence of renal failure, respiratory failure, bleeding events, and reoperations during the first 60 days after implantation significantly increased the risk of 1-year mortality. After controlling for gender, age, VAD type, and intention to treat, renal failure was the only major AE significantly associated with later mortality (hazard ratio, 2.96; p = .023). CONCLUSIONS: Specific AEs, including renal failure, respiratory and bleeding events, and reoperations, significantly decrease longer-term survival. Renal failure conferred a 3-fold increased risk of 1-year mortality. Peri-operative management should focus on strategies to mitigate risk for renal failure in order to maximize later outcomes. J Heart Lung Transplant 2010;29:981-8 (C) 2010 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

Free