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Is Implantation of a Left Ventricular Assist Device in Patients With Critical or Impending Cardiogenic Shock an Absolute Contraindication? Looking Back at Our Past Experience Trying to Identify Contraindicative Risk Factors
Author(s) -
Dell'Aquila Angelo Maria,
Schneider Stefan R.B.,
Risso Paolo,
Welp Henryk,
Glockner David G.,
Alles Sebastian,
Sindermann Jürgen R.,
Scherer Mirela
Publication year - 2015
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.12501
Subject(s) - medicine , contraindication , ventricular assist device , cardiogenic shock , cardiology , destination therapy , proportional hazards model , cohort , odds ratio , surgery , heart failure , myocardial infarction , alternative medicine , pathology
Poor survival has been demonstrated after ventricular assist device ( VAD ) implantation for Interagency Registry for Mechanically Assisted Circulatory Support ( INTERMACS ) profile 1 and 2 patients compared with more stable levels. However, risk factors within this high‐risk cohort have not been determined so far. The aim of the present study was to identify risk factors associated with this very high mortality rate. Between F ebruary 1993 and J anuary 2013, 298 patients underwent VAD implantation in our institution. One hundred nine patients were in INTERMACS level 1 and 49 patients were in INTERMACS level 2 and were therefore defined as hemodynamically critical (overall 158 patients). Assist devices implanted were: HVAD HeartWare n = 18; Incor n = 11; VentrAssist n = 2; DeBakey n = 22; and pulsatile systems n = 105. After cumulative support duration of 815.35 months, K aplan– M eier analysis revealed a survival of 63.9, 48.8, and 40.3% at 1, 6, and 12 months, respectively. Cox regression analyses identified age > 50 ( P = 0.001, odds ratio [OR] 2.48), white blood cell count > 13.000/μL ( P = 0.01, OR 2.06), preoperative renal replacement therapy ( P = 0.001, OR 2.63), and postcardiotomy failure ( P < 0.001, OR 2.79) as independent predictors of mortality. Of note, last generation VADs were not associated with significantly better 6‐month survival ( P = 0.59). Patients without the aforementioned risk factors could yield a survival of 79.2% at 6 months. This single‐center experience shows that VAD implantation in hemodynamically unstable patients generally results in poor early outcome, even in third‐generation pumps. However, avoiding the aforementioned risk factors could result in improved outcome.