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Published on: August 16, 2021
Risk factor analysis of Swedish Left Ventricular Assist Device (LVAD) patients
Hans Granfeldt1, Bansi Koul, Lars Wiklund
1Department of Cardiovascular Surgery and Anesthesia, University Hospital, Linköping, Sweden. hans.granfeldt@lio.se
Insights
Left ventricular assist devices (LVADs) support heart transplant candidates. This study identified pre-transplant risk factors for mortality and morbidity in Swedish LVAD patients, finding comparable outcomes to international data.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Medical Technology
Background:
- Left ventricular assist devices (LVADs) are a critical established therapy for patients awaiting heart transplantation.
- This study examines the Swedish experience with LVADs as a bridge to heart transplantation.
Purpose of the Study:
- To retrospectively analyze mortality and morbidity risk factors in patients treated with LVADs.
- To evaluate the effectiveness and safety of LVADs as a bridge to heart transplantation in a national cohort.
Main Methods:
- Retrospective analysis of all Swedish heart transplant candidates treated with LVADs since 1993.
- Data collection included patient demographics, diagnoses, LVAD support duration, transplant status, and pre- and post-operative clinical parameters.
Main Results:
- 18.6% of patients (11/59) died during LVAD treatment. Significant mortality risk factors included high blood transfusions, prolonged mechanical ventilation, extended ICU stay, and elevated postoperative central venous pressure.
- Preoperative high C-reactive protein, low mean arterial pressure, and high cardiac index were associated with right ventricular failure.
- 76% of patients received heart transplants, and 5.1% were weaned off the device.
Conclusions:
- The Swedish LVAD bridge-to-transplant program shows mortality and morbidity rates comparable to international benchmarks.
- Retrospective analysis identified specific pre-transplant risk factors for mortality and complications.
- Varied follow-up protocols across centers complicated definitive retrospective risk factor identification.
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, 1 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.
