Sex difference in the impact of smoking on Clinical outcomes following LVAD implantation

Abstract Background Smoking would have a negative impact on clinical outcomes following left ventricular assist device (LVAD) implantation. However, its impact on male and female cohorts separately remains uninvestigated. Purpose We aimed to investigate the association between smoking and post-LVAD outcomes among male and female cohorts separately. Methods Data of consecutive patients who received LVAD implantation at our institute between Jan 2013 and Sep 2018 were retrospectively reviewed. Clinical outcomes were compared between the never smokers and the current smokers among male and female cohorts separately. Those with former smoking were excluded. Results Of all, 85 male patients (median 56 years old) and 45 female patients (median 56 years old) were included. Among the male cohort, total readmission rate was higher in the current smokers than never smokers (incidence rate ratio 1.51, p=0.09). Rates of gastrointestinal bleeding, stroke, and hemolysis trended to be higher in current smokers (Figure 1A). Among the female cohort, these rates were not different irrespective of the smoking status (Figure 1B). Survival was not different irrespective of smoking status among both male and female cohorts. Conclusion The impact of smoking on post-LVAD outcomes seems to be different between males and females. Different therapeutic strategy might be required for the LVAD candidates with active smoking between male and female cohort. Figure 1 Funding Acknowledgement Type of funding source: None

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Winter LVAD implantation is associated with adverse clinical outcomes

The International Journal of Artificial Organs ◽

10.1177/0391398820951810 ◽

2020 ◽

pp. 039139882095181

Author(s):

Teruhiko Imamura ◽

Pamela Combs ◽

Umar Siddiqi ◽

William Cohen ◽

Stephanie Besser ◽

...

Keyword(s):

Heart Failure ◽

Seasonal Variation ◽

Confidence Interval ◽

Clinical Outcomes ◽

Winter Season ◽

Left Ventricular ◽

First Year ◽

Ventricular Assist ◽

One Year ◽

The Impact

Background: The seasonal variation of incidence and severity of heart failure is well known. However, the impact of seasonal variation on clinical outcomes following left ventricular assist device (LVAD) implantation remains unknown. Methods: We retrospectively reviewed consecutive patients who received LVAD implantation between January 2014 and December 2016 along with their first year of post-implant outcomes. Clinical outcomes were compared between those with winter LVAD implantation (between October and March) and those with non-winter LVAD implantation. Results: 168 patients with a median age of 57 years and 130 males were included. There was no seasonal difference in the number of LVAD implantations. One-year survival free from major adverse events was significantly lower in the winter implant group ( n = 88) compared to the non-winter group ( n = 80) (44% vs 61%) with an adjusted hazard ratio of 1.81 (95% confidence interval 1.11–2.90, p = 0.014), largely due to a higher rate of heart failure readmission in the winter implant patients (incidence rate ratio 2.29, 95% confidence interval 0.89–5.84). Conclusion: Patients who underwent LVAD implantation during the winter season had a higher heart failure readmission rate. A detailed mechanism and therapeutic strategy given our findings warrant further investigation.

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Cognition predicts days-alive-out-of-hospital after LVAD implantation

The International Journal of Artificial Organs ◽

10.1177/03913988211018484 ◽

2021 ◽

pp. 039139882110184

Author(s):

Marykay A Pavol ◽

Amelia K Boehme ◽

Melana Yuzefpolskaya ◽

Mathew S Maurer ◽

Jesus Casida ◽

...

Keyword(s):

Linear Regression ◽

Regression Model ◽

Linear Regression Model ◽

Left Ventricular ◽

Motor Speed ◽

Ventricular Assist ◽

Hospitalization Rates ◽

Left Ventricular Assist ◽

Patient Groups ◽

The Impact

Objective: Cognition influences hospitalization rates for a variety of patient groups but this association has not been examined in heart failure (HF) patients undergoing left ventricular assist device (LVAD) implantation. We used cognition to predict days-alive-out-of-hospital (DAOH) in patients after LVAD surgery. Methods: We retrospectively identified 59 HF patients with cognitive assessment prior to LVAD. Cognitive tests of attention, memory, language, and visual motor speed were averaged into one score. DAOH was converted to a percentage based on total days from LVAD surgery to either heart transplant or 900 days post-LVAD. Variables significantly associated with DAOH in univariate analyses were included in a linear regression model to predict DAOH. Results: A linear regression model including LVAD type (continuous or pulsatile flow) and cognition significantly predicted DAOH (F(2,54) = 6.44, p = 0.003, R2 = .19). Inspection of each variable revealed that cognition was a significant predictor in the model (β = .11, SE = .04, p = 0.007) but LVAD type was not ( p = 0.08). Conclusions: Cognitive performance assessed prior to LVAD implantation predicted how much time patients spent out of the hospital following surgery. Further studies are warranted to identify the impact of pre-LVAD cognition on post-LVAD hospitalization.

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Abstract 15226: The Impact of Chronic Obstructive Pulmonary Disease on In-hospital Outcomes Following Left Ventricular Assist Device Implantation

Circulation ◽

10.1161/circ.142.suppl_3.15226 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Bertrand Ebner ◽

Jennifer Maning ◽

Louis Vincent ◽

Jelani Grant ◽

neal olarte ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Left Ventricular Assist Device ◽

Left Ventricular ◽

Chronic Obstructive ◽

Assist Device ◽

Hospital Outcomes ◽

Ventricular Assist ◽

Obstructive Pulmonary Disease ◽

Left Ventricular Assist ◽

The Impact

Background: Chronic obstructive pulmonary disease (COPD) is well-known cause of ventricular dysfunction. However, in the setting of patients with advanced heart failure undergoing left ventricular assist device (LVAD) implantation, there is paucity data on COPD influence on in-hospital outcomes. Methods: This retrospective cohort study based on the Nationwide Inpatient Sample included all patients above 18 years all who underwent LVAD implantation from 2011 to 2017. All data was weight as recommended by Healthcare Cost and Utilization Project.Multivariate logistic regression was used to evaluate the impact of COPD on in-hospital outcomes. Results: A total of 25,503 patients underwent LVAD implantation, of those 13.8% had a pre-existing diagnosis of COPD. Individuals with COPD were older (median 62 vs. 58 years, p<0.001), more commonly male (82% vs. 76.4%, p<0.001). Patient with COPD had a greater burden of comorbidities confirmed by significant higher rate of hypertension, diabetes, atrial tachyarrhythmias, dyslipidemia, prior stroke, coronary and peripheral artery diseases, pulmonary hypertension, and chronic kidney disease (p<0.001 for all). No significant difference was found in in-hospital stroke, infections, short-term percutaneous mechanical circulatory support, implant related complications, and LVAD thrombosis. There was a significant higher rate of inpatient acute kidney injury, major bleeding, cardiac complications, thromboembolism, and cardiac arrest in patients without COPD (p<0.05 for all outcomes). Compared to patients without COPD, individuals with COPD had a lower mortality (6.2% vs. 12.4%; OR 0.59; C.I. 0.512-0.685; p<0.05). Conclusion: Patients with COPD undergoing LVAD implantation have higher comorbidities, however, it is not associated with increase in-hospital all-cause mortality.Further studies are needed to analyze the differences found between these two groups in more detail.

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Ventricular Fibrillation After Release of an Aortic Cross-Clamp in Valvular Surgery: Independent Risk Factors, Outcomes, and Incidence from Access Routes

10.21203/rs.3.rs-697996/v1 ◽

2021 ◽

Author(s):

Weichao LI ◽

heng li ◽

Jianping Gong ◽

Weihua Liu ◽

BaoJun Fu ◽

...

Keyword(s):

Risk Factors ◽

Ventricular Fibrillation ◽

Clinical Outcomes ◽

Valve Replacement ◽

Smoking Status ◽

Left Ventricular ◽

Aortic Cross Clamp ◽

Valvular Surgery ◽

Htk Solution ◽

Independent Risk Factors

Abstract Background Predictors and clinical outcomes of VF-ACC and the relative VF-ACC incidence with various access routes have not been well documented. This study aimed to identify predictors, clinical outcomes, and relative incidences of ventricular fibrillation after the release of an aortic cross-clamp (VF-ACC) with various access routes in valvular surgery.Patients and methods In this single-center and retrospective cohort study, we screened 228 consecutive patients undergoing valve surgery, and a total of 119 patients were included in the study. The primary outcomes were the relative incidence and predictors of VF-ACC with access routes, and secondary endpoints included effects of VF-ACC on 30-day mortality, perioperative ventricular arrhythmias (VAs), and heart failure with ejection fraction < 50% (HFEF < 50%).Results VF-ACC incidence varied on the basis of access routes. VF-ACC occurred in 58.3% of patients with aortic valve replacement via transverse aortotomy (TAo-AVR), in 48.6% of patients with aortic and mitral replacements via transseptal and transverse aortotomy access (TSAo-MAVR), and in 20% of patients with mitral valve replacement via transseptal access (TS-MVR). Seven independent risk factors were identified: HTK solution (AOR: 4.90, p = 0.002), smoking status (AOR: 6.30, p = 0.001), cerebrovascular disease (CBD) [(AOR: 7.08, p = 0.022)], regional wall motion abnormality (RWMA) [(AOR: 8.33, p < 0.001)], perioperative VAs (AOR: 4.85, p = 0.001), HFEF < 50% (AOR: 5.66, p = 0.002), and left ventricular mass index (LVMI) [(AOR: 0.962, CI: 0.941–0.984)].Conclusions VF-ACC was the most common in TAo-AVR and the least common in TS-MVR. HTK solution, smoking status, CBD, perioperative VAs, HFEF < 50%, and RWMA were associated with an increased risk of VF-ACC, and low LVMI acted as a protective factor. Patients with VF-ACC commonly experienced perioperative VAs or HFEFs < 50%.Clinical trial registration: ChiCTR2100050961.

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Long-term use of left ventricular assist devices: a report on clinical outcomes

Canadian Journal of Surgery ◽

10.1503/cjs.010016 ◽

2017 ◽

Vol 60 (4) ◽

pp. 236-246 ◽

Cited By ~ 9

Author(s):

Sneha Raju ◽

Jane MacIver ◽

Farid Foroutan ◽

Carolina Alba ◽

Filio Billia ◽

...

Keyword(s):

Clinical Outcomes ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Left Ventricular Assist Devices ◽

Ventricular Assist ◽

Assist Devices ◽

Left Ventricular Assist

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Impact of Obesity on Heart Transplantation Outcomes

Journal of the American Heart Association ◽

10.1161/jaha.121.021346 ◽

2021 ◽

Vol 10 (23) ◽

Author(s):

Fouad Chouairi ◽

Aidan Milner ◽

Sounok Sen ◽

Avirup Guha ◽

James Stewart ◽

...

Keyword(s):

Heart Transplantation ◽

Organ Procurement ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Left Ventricular Assist Devices ◽

Ventricular Assist ◽

Allocation System ◽

Increased Risk ◽

The Impact ◽

Transplantation Outcomes

Background Patients with obesity and advanced heart failure face unique challenges on the path to heart transplantation. There are limited data on waitlist and transplantation outcomes in this population. We aimed to evaluate the impact of obesity on heart transplantation outcomes, and to investigate the effects of the new organ procurement and transplantation network allocation system in this population. Methods and Results This cohort study of adult patients listed for heart transplant used the United Network for Organ Sharing database from January 2006 to June 2020. Patients were stratified by body mass index (BMI) (18.5–24.9, 25–29.9, 30–34.9, 35–39.9, and 40–55 kg/m 2 ). Recipient characteristics and donor characteristics were analyzed. Outcomes analyzed included transplantation, waitlist death, and posttransplant death. BMI 18.5 to 24.9 kg/m 2 was used as the reference compared with progressive BMI categories. There were 46 645 patients listed for transplantation. Patients in higher BMI categories were less likely to be transplanted. The lowest likelihood of transplantation was in the highest BMI category, 40 to 55 kg/m 2 (hazard ratio [HR], 0.19 [0.05–0.76]; P =0.02). Patients within the 2 highest BMI categories had higher risk of posttransplantation death (HR, 1.29; P <0.001 and HR, 1.65; P <0.001, respectively). Left ventricular assist devices among patients in obese BMI categories decreased after the allocation system change ( P <0.001, all). After the change, patients with obesity were more likely to undergo transplantation (BMI 30–35 kg/m 2 : HR, 1.31 [1.18–1.46], P <0.001; BMI 35–55 kg/m 2 : HR, 1.29 [1.06–1.58]; P =0.01). Conclusions There was an inverse relationship between BMI and likelihood of heart transplantation. Higher BMI was associated with increased risk of posttransplant mortality. Patients with obesity were more likely to undergo transplantation under the revised allocation system.

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Impact of Cardiac Resynchronization Therapy on Clinical Outcomes in Patients With Continuous-Flow Left Ventricular Assist Devices

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2014.12.006 ◽

2015 ◽

Vol 21 (3) ◽

pp. 226-232 ◽

Cited By ~ 27

Author(s):

Rakesh Gopinathannair ◽

Emma J. Birks ◽

Jaimin R. Trivedi ◽

Kelly C. McCants ◽

Brad S. Sutton ◽

...

Keyword(s):

Cardiac Resynchronization Therapy ◽

Clinical Outcomes ◽

Continuous Flow ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Cardiac Resynchronization ◽

Left Ventricular Assist Devices ◽

Resynchronization Therapy ◽

Ventricular Assist ◽

Left Ventricular Assist

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Abstract 217: Characteristics and 1-year Outcomes of Patients with Long-term Left Ventricular Assist Devices (LVAD) in Quebec Compared with the INTERMACS Registry

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.217 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Laurie J Lambert ◽

Georgeta Sas ◽

Nataliya Dragieva ◽

Lucy J Boothroyd ◽

Anique Ducharme ◽

...

Keyword(s):

Adverse Events ◽

Clinical Outcomes ◽

Clinical Results ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Destination Therapy ◽

Left Ventricular Assist Devices ◽

Ventricular Assist ◽

Left Ventricular Assist

Introduction: After a review of the evidence, our publicly funded cardiology evaluation unit recommended to the Quebec Ministry of Health that use of long-term left ventricular assist devices (LVAD) should be carefully monitored and not limited to bridge-to-transplant patients. Herein, we describe use of LVAD and 1-year results in Quebec compared with the INTERMACS registry. Methods: A retrospective review of all pertinent hospital data sources of all LVAD-implanted patients in 20102-12 was performed. Variables, definitions and time points (pre-implant, implant, 1 month, 1 year) were based on the INTERMACS registry and results were compared during the same period. Major clinical outcomes (death, transplant, recovery) and adverse events were determined during 1-year follow up for the entire cohort. Results: During 2010-2012, 53 LVADs were implanted in Quebec (3 centers). Patients were mostly male (77 %) with a median age of 57 years (interquartile range, IQR: 50-60); 34% were ≥60 years old compared to 47% in INTERMACS. The proportion of Quebec patients with an INTERMACS profile 1 (critical cardiogenic shock; 13%) and 2 (progressive decline; 40%) were very similar to INTERMACS. However, the proportion with INTERMACS profile 3 (stable, inotrope-dependent) was higher in Quebec (43%) than in INTERMACS (27%); in the latter, more patients had INTERMACS profiles 4 (symptoms at rest) to 7 (NYHA Class III). Forty-nine percent of Quebec patients were not on the transplant list at the time of implantation compared to 75% in INTERMACS. LVAD as destination therapy was much less frequent in Quebec (11%) than in INTERMACS (36%). After LVAD implantation, median intensive care unit stay was 7 days (IQR: 5-14) and median hospital stay for patients who were discharged on support was 24 days (IQR: 20 - 41). At 1-year, major clinical outcomes of Quebec patients (alive on support 57%; died on support 17%; transplant 24%; explant 2%) were virtually identical to those in INTERMACS. One-year survival for patients on versus not on the transplant list at the time of implantation was not significantly different (p=0.13). As in INTERMACS patients, the most frequent adverse events in Quebec patients were infection, hemorrhage, arrhythmia and right heart failure. Conclusion: In comparison with INTERMACS patients, Quebec LVAD patients are younger but sicker and less likely to be implanted as destination therapy. Despite low volumes, clinical results in Quebec hospitals are very similar to those reported for INTERMACS. Only half of Quebec LVAD patients were on the transplant list at the time of implant. Similar clinical results for patients on and off the transplant list in Quebec support the recommendation that transplant eligibility should not be an essential criterion for selection of patients for LVAD. Continued independent monitoring in collaboration with hospitals will be important to optimize quality of care.

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