Risk Factors for Mechanical Circulatory Support Use and Risk Assessment

2020 ◽  
pp. 623-639
Author(s):  
Rajakrishnan Vijayakrishnan ◽  
Emma J. Birks
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Mechanical Circulatory Support ◽  
Circulatory Support

Risk Factors for Cardiac Arrest or Mechanical Circulatory Support in Children with Fulminant Myocarditis

2016 ◽  
Vol 38 (1) ◽  
pp. 128-134 ◽  
Author(s):  
Joseph R. Casadonte ◽  
Mjaye L. Mazwi ◽  
Katheryn E. Gambetta ◽  
Hannah L. Palac ◽  
Mary E. McBride ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Arrest ◽  
Mechanical Circulatory Support ◽  
Fulminant Myocarditis ◽  
Circulatory Support

300: Risk Factors for Neurological Events in Long-Term Mechanical Circulatory Support Patients

2008 ◽  
Vol 27 (2) ◽  
pp. S168
Author(s):  
C.N. Madsen ◽  
M.R. Dowdle ◽  
B.D. Horne ◽  
M.R. Bonnell ◽  
A. Kfoury ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Circulatory Support ◽  
Circulatory Support

Impact of mechanical circulatory support on post-transplant stroke risk

2021 ◽  
Vol 44 (10) ◽  
pp. 675-680
Author(s):  
Nandini Nair ◽  
Shengping Yang ◽  
Enrique Gongora
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Mechanical Circulatory Support ◽  
Stroke Risk ◽  
Total Artificial Heart ◽  
Circulatory Support ◽  
Study Cohort ◽  
Mechanical Support ◽  
Ischemic Time ◽  
Post Transplant

The effect of type of mechanical circulatory support on stroke risk during the early post-transplant period remains undefined in patients bridged to transplant. This study assesses if the type of circulatory support device affects stroke risk in this population. The study cohort of 4257 adult patients bridged with mechanical support to cardiac transplant were derived from the UNOS transplant registry data. Risk factors assessed were age, gender, ischemic time, diabetes (recipient), durable mechanical support at listing and mechanical ventilation pre-transplant. Descriptive statistics were used to describe characteristics of the study cohort. Univariate logistic regression was used to test if there is a significant association between stroke event and all the potential risk factors. Multivariate logistic regression was used to test such associations while adjusting for all other risk factors. Odds ratios (ORs) and their 95% confidence intervals (CIs) in parenthesis, were calculated. p < 0.05 was considered significant. Patients on Extracorporeal membrane oxygenation (ECMO) had the highest risk of stroke immediately post-transplant prior to discharge (OR 3.03, {1.16, 7.95}) followed by Total Artificial Heart (TAH) (OR 2.03, {1.01, 4.07) as compared to those only on a Left Ventricular Assist Device (LVAD). Ischemic time (OR 1.3 {1.09, 1.45}) and diabetes (OR 1.8 {1.29, 2.51}) were significant risk factors. Patients on ECMO and TAH had a 203% and 103% increase respectively in the odds of having a stroke prior to discharge as compared to those only on LVADS.

scholarly journals Predictors of late right heart failure after mechanical circulatory support

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Felix ◽  
M.I.F Oerlemans ◽  
F.W Asselbergs ◽  
L.W Van Laake ◽  
N De Jonge
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Right Ventricular ◽  
Mechanical Circulatory Support ◽  
Cox Regression ◽  
Right Heart Failure ◽  
Index Admission ◽  
Circulatory Support ◽  
Right Heart

Abstract Introduction Right heart failure (RHF) is associated with a worse outcome in mechanical circulatory support (MCS). Several studies have identified risk factors for RHF shortly after MCS, though information about late RHF is limited. Purpose We aimed to identify risk factors for late RHF in patients with MCS, implanted as a bridge to heart transplantation. Methods Data of all patients, who were successfully discharged after MCS implantation in a University Medical Center between 2006–2019 were included and follow-up was completed until March 2019. Late RHF was defined as the occurrence of right ventricular dysfunction associated with symptoms, including jugular venous distension, hepatic congestion and peripheral edema during MCS support, if diagnosed after the index admission for MCS implantation. The primary end point was the diagnosis of late RHF in combination with the need for intensification of diuretics (either with or without hospitalization) and/or the need for inotropes and/or right ventricular assist device. Univariable and multivariable Cox regression analyses were performed to identify risk factors for late RHF. Results 262 patients (66% male, mean age 51±13 years) had a mean follow-up of 901±643 days. 49 (18.7%) patients suffered from late RHF after a median of 363 (IQR 131–1001) days. Multivariable risk factors for late RHF were a higher body mass index (hazard ratio (HR) 1.05; CI 1.00–1.11), a history of atrial fibrillation (AF) prior to the operation (HR 2.11; CI 1.12–3.96), a lower (i.e. clinically worse) INTERMACS profile and a longer duration on the intensive care unit (HR 1.03; CI 1.00–1.06) during the index admission for MCS implantation (Table 1). The occurrence of early RHF was not associated with late RHF (p=0.211). Conclusion Late RHF is a clinically important adverse event in MCS, affecting approximately 20% of patients. Risk factors associated with late RHF most relate to the severity of the clinical situation at the time of implantation. Funding Acknowledgement Type of funding source: None

Mechanical circulatory support as a bridge to cardiac transplantation: toward the 21st century

1999 ◽  
Vol 8 (5) ◽  
pp. 324-337 ◽  
Author(s):  
K Scherr ◽  
L Jensen ◽  
A Koshal
Keyword(s):  
Risk Factors ◽  
21St Century ◽  
Cardiac Transplantation ◽  
Mechanical Circulatory Support ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Mechanical Support ◽  
Donor Organ ◽  
Ventricular Assist ◽  
Selection Of

Mechanical circulatory support is used to sustain the lives of patients awaiting cardiac transplantation who would otherwise die before a donor organ became available. Currently available ventricular assist devices used for mechanical circulatory support, risk factors and complications associated with use of these devices, and selection of candidates for treatment with mechanical support as a bridge to cardiac transplantation are reviewed. The importance of early insertion of the devices before end-organ dysfunction occurs is examined.

Risk Factors for Survival After Heart Transplantation in Children and Young Adults: A 22-Year Study of 179 Transplants

2018 ◽  
Vol 9 (5) ◽  
pp. 557-564 ◽  
Author(s):  
Shawn Shah ◽  
Alfred Asante-Korang ◽  
Sharon R. Ghazarian ◽  
Gary Stapleton ◽  
Carrie Herbert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Heart Transplantation ◽  
Mechanical Circulatory Support ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Circulatory Support ◽  
Kaplan Meier ◽  
Diagnostic Characteristics

Background: This article reviews all patients who underwent heart transplantation (HTx) within a single institution (172 patients underwent 179 HTx [167 first-time HTxs, 10 second HTxs, 2 third HTxs]) to describe diagnostic characteristics, management protocols, and risk factors for mortality. Methods: Descriptive analysis was performed for the entire cohort using mean, standard deviation, median, interquartile range, and overall range, as appropriate. Univariable and multivariable Cox proportional hazards models were performed to identify prognostic factors for outcomes over time. The primary outcome of interest was mortality, which was modeled by Kaplan-Meier analysis. Results: Median age at HTx was 263 days (range, 5 days to 24 years; mean = 4.63 ± 5.95 years; 18 neonates, 79 infants). Median weight at HTx was 7.5 kg (range, 2.2-113 kg; mean = 19.36 ± 23.54). Diagnostic categories were cardiomyopathy (n = 62), primary transplantation for hypoplastic left heart syndrome (HLHS) or HLHS-related malformation (n = 33), transplantation after cardiac surgery for HLHS or HLHS-related malformation (n = 17), non-HLHS congenital heart disease (n = 55), and retransplant (n = 12). Operative mortality was 10.1% (18 patients). Cumulative total follow-up is 1,355 years. Late mortality was 18.4% (33 patients). Overall Kaplan-Meier five-year survival was 76.2%. One hundred twenty-one patients are alive with a mean follow-up of 7.61 ± 6.46 years. No survival differences were seen among the five diagnostic subgroups ( P = .064) or between immunosensitized patients (n = 31) and nonimmunosensitized patients (n = 141; P = .422). Conclusions: Excellent results are expected for children undergoing HTx with comparable results among diagnostic groups. Pretransplant mechanical circulatory support and posttransplant mechanical circulatory support are risk factors for decreased survival. Survival after transplantation for HLHS or HLHS-related malformation is better with primary HTx in comparison to HTx after prior cardiac surgery.

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