Association of timing of percutaneous left ventricular assist device insertion with outcomes in patients undergoing cardiac surgery

被引：2

作者：

Maigrot, Jean-Luc A. ^{[1
]}

Starling, Randall C. ^{[2
]}

Taimeh, Ziad ^{[2
]}

Tong, Michael Z. Y. ^{[1
]}

Soltesz, Edward G. ^{[1
]}

Weiss, Aaron J. ^{[1
]}

机构：

[1] Cleveland Clin, Heart Vasc & Thorac Inst, Kaufman Ctr Heart Failure Treatment & Recovery, Dept Thorac & Cardiovasc Surg, Cleveland, OH USA

[2] Cleveland Clin, Heart Vasc & Thorac Inst, Kaufman Ctr Heart Failure Treatment & Recovery, Dept Cardiovasc Med, Cleveland, OH USA

来源：

JTCVS OPEN | 2023年 / 16卷

关键词：

temporary mechanical circulatory support; national database; outcomes; transvalvular microaxial pump; Impella; Impella-assisted cardiac surgery; MECHANICAL CIRCULATORY SUPPORT; RISK-FACTORS; US PATIENTS; IMPELLA;

D O I：

10.1016/j.xjon.2023.10.028

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives: The aim of this study was to explore the associations between percutaneous ventricular assist device (pVAD) insertion timing relative to cardiac surgery and patient outcomes. Methods: The Nationwide Inpatient Sample was queried for patients undergoing cardiac surgery and pVAD insertion in the same admission from 2016 to 2019. Patients were stratified by timing of pVAD insertion. Preoperative characteristics, postoperative complications, and mortality were compared among groups. Results: Overall, 3695 patients underwent cardiac surgery and pVAD insertion during the same hospitalization (pre: 1130, intra: 1690, and post: 875). The distribution of cardiac surgery procedures was similar across groups. Median Elixhauser Comorbidity Index was 13 for pre-, 15 for intra-, and 17 for postoperative pVAD patients (P = .021). Patients who received a postoperative pVAD were associated with increased mortality (pre: 18%, intra: 39%, and post: 54%; P < .01). Increased complication rates were also associated with postoperative pVAD insertion (pre: 61%, intra: 55%, and post: 75%; P < .01). Preoperative pVAD insertion was associated with increase rates of sepsis (pre: 18%, intra: 9.8%, and post: 17%; P = .01) and pneumonia (pre: 38%, intra: 23%, and post: 31%; P < .01). Postoperative pVAD insertion was associated with increased rates of gastrointestinal bleeding (pre: 2.2%, intra: 3.0%, and post: 7.4%; P = .01), renal failure (pre: 10%, intra: 9.2%, and post: 17%; P = .01), and prolonged ventilation (pre: 44%, intra: 41%, and post: 54%; P = .02). Conclusions: Postoperative pVAD insertion following cardiac surgery was associated with increased complications and mortality compared with preoperative or intraoperative insertion. Further studies should explore optimal utilization and timing of pVAD insertion in patients undergoing cardiac surgery. insertion with outcomes in patients undergoing cardiac surgery

引用

页码：430 / 446

页数：17

共 26 条

[1]

Agency for Healthcare Research and Quality, NIS database documentation

[2] Perioperative Impella 5.5 Support for Surgical Aortic Valve Replacement: Pull Back/Push Through Technique, Safeguards, and Pitfalls [J].