Risk factor analysis of Swedish left ventricular assist device (LVAD) patients

被引:9
作者
Granfeldt, H [1 ]
Koul, B
Wiklund, L
Peterzén, B
Lönn, U
Babic, A
Ahn, HC
机构
[1] Univ Hosp, Dept Cardiovasc Surg, S-58185 Linkoping, Sweden
[2] Univ Hosp, Dept Anesthesia, S-58185 Linkoping, Sweden
[3] Univ Hosp, Inst Med Informat, S-58185 Linkoping, Sweden
[4] Univ Lund Hosp, S-22185 Lund, Sweden
[5] Univ Hosp, Gothenburg, Sweden
[6] Univ Hosp, Uppsala, Sweden
关键词
D O I
10.1016/S0003-4975(03)01016-6
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. The use of left ventricular assist devices (LVADs) is established as a bridge to heart transplantation. Methods. All Swedish patients on the waiting list for heart transplantation, treated with LVAD since 1993 were retrospectively collected into a database and analyzed in regards to risk factors for mortality and morbidity. Results. Fifty-nine patients (46 men) with a median age of 49 years (range, 14 to 69 years), Higgins score median of 9 (range, 3 to 15), EuroScore median of 10 (range, 5 to 17) were investigated. Dominating diagnoses were dilated cardiomyopathy in 61% (n = 36) and ischemic cardiomyopathy in 18.6% (n = 11). The patients were supported with LVAD for a median time of 99.5 days (range, I to 873 days). Forty-five (76%) patients received transplants, and 3 (5.1%) patients were weaned from the device. Eleven patients (18.6%) died during LVAD treatment. Risk factor analysis for mortality before heart transplantation showed significance for a high total amount of autologous blood transfusions (p < 0.001), days on mechanical ventilation postoperatively (p < 0.001), prolonged postoperative intensive care unit stay (p = 0.007), and high central venous pressure 24 hours postoperatively and at the final measurement (p = 0.03 and 0.01, respectively). Mortality with LVAD treatment was 18.6% (n = 11). High C-reactive protein (p = 0.001), low mean arterial pressure (p = 0.03), and high cardiac index (p = 0.03) preoperatively were risk factors for development of right ventricular failure during LVAD treatment. Conclusions. The Swedish experience with LVAD as a bridge to heart transplantation was retrospectively collected into a database. This included data from transplant and nontransplant centers. Figures of mortality and morbidity in the database were comparable to international experience. Specific risk factors were difficult to define retrospectively as a result of different protocols for follow-up among participating centers. (C) 2003 by The Society of Thoracic Surgeons.
引用
收藏
页码:1993 / 1998
页数:6
相关论文
共 24 条
[1]   Diagnosis and management of left ventricular assist device valve-endocarditis: LVAD valve replacement [J].
de Jonge, KC ;
Laube, HR ;
Dohmen, PM ;
Ivancevic, V ;
Konertz, WF .
ANNALS OF THORACIC SURGERY, 2000, 70 (04) :1404-1405
[2]   Complications of circulatory assist [J].
El-Banayosy, A ;
Arusoglu, L ;
Kizner, L ;
Fey, O ;
Minami, K ;
Körfer, R .
PERFUSION-UK, 2000, 15 (04) :327-331
[3]   Novacor left ventricular assist system versus HeartMate vented electric left ventricular assist system as a long-term mechanical circulatory support device in bridging patients:: A prospective study [J].
El-Banayosy, A ;
Arusoglu, L ;
Kizner, L ;
Tenderich, G ;
Minami, K ;
Inoue, K ;
Körfer, R .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2000, 119 (03) :581-587
[4]   Multicenter clinical evaluation of the HeartMate vented electric left ventricular assist system in patients awaiting heart transplantation [J].
Frazier, OH ;
Rose, EA ;
Oz, MC ;
Dembitsky, W ;
McCarthy, P ;
Radovancevic, B ;
Poirier, VL ;
Dasse, KA .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2001, 122 (06) :1186-1195
[5]   Preoperative risk factors for right ventricular failure after implantable left ventricular assist device insertion [J].
Fukamachi, K ;
McCarthy, PM ;
Smedira, NG ;
Vargo, RL ;
Starling, RC ;
Young, JB .
ANNALS OF THORACIC SURGERY, 1999, 68 (06) :2181-2184
[6]   THE LINKOPING-LUND SURGICAL EXPERIENCE WITH THE HEARTMATE LEFT-VENTRICULAR ASSIST SYSTEM [J].
GRANFELDT, H ;
SOLEM, JO ;
LONN, U ;
PETERZEN, B ;
CARNSTAM, B ;
DAHLSTROM, U ;
JANSSON, K ;
KOUL, B ;
STEEN, S ;
TOOM, M ;
RUTBERG, H ;
NYLANDER, E ;
CASIMIRAHN, H .
ANNALS OF THORACIC SURGERY, 1995, 59 (02) :S52-S55
[7]   Influence of inhaled nitric oxide on systemic flow and ventricular filling pressure in patients receiving mechanical circulatory assistance [J].
Hare, JM ;
Shernan, SK ;
Body, SC ;
Graydon, E ;
Colucci, WS ;
Couper, GS .
CIRCULATION, 1997, 95 (09) :2250-2253
[8]  
Herrmann M, 1997, CIRCULATION, V95, P814
[9]   STRATIFICATION OF MORBIDITY AND MORTALITY OUTCOME BY PREOPERATIVE RISK-FACTORS IN CORONARY-ARTERY BYPASS PATIENTS - A CLINICAL SEVERITY SCORE [J].
HIGGINS, TL ;
ESTAFANOUS, FG ;
LOOP, FD ;
BECK, GJ ;
BLUM, JM ;
PARANANDI, L .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1992, 267 (17) :2344-2348
[10]   ICU admission score for predicting morbidity and mortality risk after coronary artery bypass grafting [J].
Higgins, TL ;
Estafanous, FG ;
Loop, FD ;
Beck, GJ ;
Lee, JC ;
Starr, NJ ;
Knaus, WA ;
Cosgrove, DM .
ANNALS OF THORACIC SURGERY, 1997, 64 (04) :1050-1058