NATIONAL GENDER-BASED IN-HOSPITAL MORTALITY AND OUTCOME IN PATIENTS WITH LEFT VENTRICULAR ASSIST DEVICE: 2008-2014 NATIONAL INPATIENT SAMPLE TREND ANALYSIS

2020 ◽  
Vol 75 (11) ◽  
pp. 1507
Author(s):  
Neelkumar Patel ◽  
Dhrubajyoti Bandyopadhyay ◽  
Sandipan Chakraborty ◽  
Birendra Amgai ◽  
Aneeta Kumari ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Trend Analysis ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
National Inpatient Sample ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
Gender Based

Abstract 12718: Ethnic Disparities in Outcomes After Left Ventricular Assist Device Implantation: An Analysis of National Inpatient Sample

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hiroki Ueyama ◽  
Aaqib H Malik ◽  
Toshiki Kuno ◽  
Yujiro Yokoyama ◽  
Suchith Shetty ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
National Inpatient Sample ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist

Introduction: Previous studies of patients undergoing various cardiac surgeries demonstrated worse outcomes among African American (AA) patients. It remains unclear if race is a predictor of outcomes among Left Ventricular Assist Device (LVAD) recipients. Methods: Patients who underwent LVAD implantation between 2010 and 2017 were identified using the national inpatient sample (NIS). Race was classified as Caucasians vs. AA vs. Hispanics, and endpoints were in-hospital outcomes, length of stay and cost. Procedure-related complications were identified via ICD-9 and ICD-10 coding and analysis was performed via mixed effect models. Results: A total of 27,132 adults (5,114 unweighted) underwent LVAD implantation in the U.S. between 2010 and 2017, including Caucasians (63.8%), AA (23.8%) and Hispanics (6%). The number of LVAD implantations increased in both Caucasians and AA during the study period. AA LVAD recipients were younger, with higher rates of females and most of the comorbidities, but lower rates of coronary artery disease and coronary artery bypass grafting compared to Caucasians and Hispanics. Medicaid and median income at the lowest quartile were more frequent among AA LVAD recipients. We did not identify differences in in-hospital mortality, stroke, bleeding complications, infectious complications, and acute kidney injury requiring hemodialysis among racial groups (Table). AA LVAD recipients had lower rates of routine discharge than Caucasians and Hispanics, longer length of stay than Caucasians but similar cost of hospitalization. After adjustment with age gender and clinical comorbidities, race was not a predictor of in-hospital mortality. Conclusions: We identified differences in clinical characteristics but not in in-hospital complications among LVAD recipients of different race.

scholarly journals Outcomes of Hospitalizations for Cardiogenic Shock at Left Ventricular Assist Device Versus Non–Left Ventricular Assist Device Centers

2020 ◽  
Vol 9 (23) ◽  
Author(s):  
Joseph I. Wang ◽  
Daniel Y. Lu ◽  
MHS ◽  
Dmitriy N. Feldman ◽  
Stephen A. McCullough ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist

Background Cardiogenic shock (CS) is a complex syndrome associated with high morbidity and mortality. In recent years, many US hospitals have formed multidisciplinary shock teams capable of rapid diagnosis and triage. Because of preexisting collaborative systems of care, hospitals with left ventricular assist device (LVAD) programs may also represent “centers of excellence” for CS care. However, the outcomes of patients with CS at LVAD centers have not been previously evaluated. Methods and Results Patients with CS were identified in the 2012 to 2014 National Inpatient Sample. Clinical characteristics, revascularization rates, and use of mechanical circulatory support were analyzed in LVAD versus non‐LVAD centers. The association between hospital type and in‐hospital mortality was examined using multivariable logistic regression models. Of 272 075 hospitalizations, 26.0% were in LVAD centers. CS attributable to causes other than acute myocardial infarction represented most cases. In‐hospital mortality was lower in LVAD centers (38.9% versus 43.3%; P <0.001). In multivariable analysis, the odds of mortality remained significantly lower for hospitalizations in LVAD centers (odds ratio, 0.89; P <0.001). In patients with CS secondary to acute myocardial infarction, revascularization rates were similar between LVAD and non‐LVAD centers. The use of intra‐aortic balloon pump (18.7% versus 18.8%) and Impella/TandemHeart (2.6% versus 1.9%) was similar between hospital types, whereas extracorporeal membrane oxygenation was used more frequently in LVAD centers (4.3% versus 0.2%; P <0.001). Conclusions Risk‐adjusted mortality was lower in patients with CS who were hospitalized at LVAD centers. These centers likely represent specialized, shock team capable institutions across the country that may be best suited to manage patients with CS.

Abstract 14490: Sarcopenia Defined by Computed Tomography Psoas Muscle Area Predicts Morbidity and Mortality in Patients Undergoing Left Ventricular Assist Device Implantation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yojiro Koda ◽  
Hidefumi Nishida ◽  
Ann Nguyen ◽  
Bow Chung ◽  
Gene H Kim ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Psoas Muscle ◽  
Left Ventricular ◽  
Assist Device ◽  
Muscle Area ◽  
Term Survival ◽  
Ventricular Assist ◽  
Left Ventricular Assist

Objective: This study aimed to assess the correlation between psoas-muscle sarcopenia and clinical outcomes in patients undergoing left ventricular assist device (LVAD) implantation. Methods: Patients who underwent a LVAD implantation and had a perioperative CT available were included. Bilateral psoas muscle cross-sectional areas at the level of L3 were measured, and a total psoas muscle area was divided by a body surface area (BSA) to calculate total psoas muscle area index (TPAI). Sarcopenia was defined as TPAI<7.5 cm 2 /m 2 , and the cohort was divided into Sarcopenia group (S group) and Non-sarcopenia group (NS group). Postoperative complications, in-hospital mortality, and overall survival were retrospectively assessed. Results: Between 7.2008-1.2020, a total of 513 patients underwent a LVAD implantation. Among them, 244 patients with a qualified CT study were identified. The S group was 127 patients (52%), and the NS group was 117 patients (48%). There were no differences in patient characteristics including age, comorbidity, INTERMACS classification, except BSA (S group vs. NS group: 1.99±0.27 vs. 2.07±0.28, p=0.0372) and female gender (S group vs. NS group: 39% vs. 20%, p=0.0011). Postoperative acute kidney injury (AKI) (22% vs. 9%, p=0.0030), newly required dialysis (16% vs. 5%, p=0.0058), and in-hospital mortality (13% vs. 4%, p=0.0174) were higher in the S group compared with the NS group. The causes of in-hospital mortality in the S group included right ventricular failure (RVF) (N=4), stroke (N=4; cerebral hemorrhage 3, subarachnoid hemorrhage 1), sepsis (N=3), respiratory failure (N=2) , bowel ischemia (N=2), bowel perforation (N=1). Those in the NS group were RVF (N=3), sepsis (N=1), and liver failure (N=1). Overall long-term survival was similar with both groups (S group vs. NS group: 72±4 vs. 75±4% at 1 year, 53±5 vs. 53±6% at 3 years, 40±6 vs. 34±9% at 5 years, Log-Rank P=0.6356). The Youden index identified the cut-off value of TPAI of 7.2cm 2 /m 2 for in-hospital mortality (area under curve, 0.699; sensitivity, 76.2%; specificity, 54.3%). Conclusions: Sarcopenia (TPAI<7.5 cm 2 /m 2 ) was a predictor for postoperative AKI and in-hospital mortality in patients undergoing a LVAD implantation.

Abstract P445: Implications of Associated Infection in Intracranial Hemorrhages During Left Ventricular Assist Device Support

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Aaron Shoskes ◽  
Catherine Hassett ◽  
Sung-min Cho ◽  
Jerry Estep ◽  
Randall C Starling ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Blood Stream Infection ◽  
Tertiary Care ◽  
Left Ventricular ◽  
Subdural Hemorrhage ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist

Background: Intracranial hemorrhage (ICH) is a devastating complication in patients with an implanted left ventricular assist device (LVAD) for advanced heart failure. Blood stream infection is associated with LVAD-associated ICH. We compared infectious and non-infectious ICH among LVAD recipients. Methods: Records of patients who had LVAD implantation at a tertiary care center were retrospectively reviewed. All LVAD-associated ICH were analyzed, including intraparenchymal hemorrhage (IPH), subarachnoid hemorrhage (SAH), and subdural hemorrhage (SDH). Hemorrhages were categorized into infectious and non-infectious by presence or absence of concurrent bacteremia or driveline infection. Results: Of 683 patients with an LVAD, 74 ICHs occurred in 73 patients (10.7%). IPH was most prevalent (72%), followed by SAH (27%), and SDH (23%). Multiple concurrent subtypes of hemorrhage were present in 22% of events. ICH occurred at median 188 days after implant, and was associated with a 54% in-hospital mortality. Twenty-three ICHs occurred in the setting of infection. While 20% of overall ICH occurred within 30 days of LVAD implantation, only 1 infectious ICH occurred within 30 days of implantation (4.5%). IPH without associated infection was larger (median 41 ml, interquartile range [IQR] 11-70) than without infection (median 9 ml, IQR 2-65, p= 0.04), but in hospital mortality did not differ between infectious and non-infectious ICH (52% vs 59%) or IPH (58% vs 68%). Conclusion: While timing and volume of infectious and non-infectious ICH differ, in-hospital mortality is similarly high in both groups. Further research is necessary to better understand hemorrhagic complications in LVAD patients.

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