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A left ventricular end-diastolic dimension less than 6.0 cm is associated with mortality after implantation of an

Masashi Kawabori1, Chitaru Kurihara2, Ryan Conyer1

  • 1Division of Cardiothoracic Transplantation and Circulatory Support, Baylor College of Medicine, Houston, Tex; Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, Tex.

The Journal of Thoracic and Cardiovascular Surgery
|February 25, 2019
PubMed

Insights

Patients receiving a HeartMate II left ventricular assist device with a left ventricular end-diastolic dimension below 6.0 cm experienced decreased survival and increased stroke risk. This finding highlights the importance of preoperative left ventricular size in device selection and future design considerations.

Area of Science:

  • Cardiology
  • Medical Devices
  • Heart Failure Management

Background:

  • The impact of preoperative left ventricular end-diastolic dimension (LVEDD) on outcomes after HeartMate II left ventricular assist device (LVAD) implantation is not fully understood.
  • Assessing LVEDD is crucial for optimizing patient selection and improving outcomes in advanced heart failure.
  • HeartMate II is a widely used mechanical circulatory support device for end-stage heart failure.

Purpose of the Study:

  • To investigate the association between preoperative LVEDD and outcomes in patients undergoing primary HeartMate II LVAD implantation.
  • To identify a specific LVEDD cutoff value predictive of worse overall survival post-LVAD implantation.
  • To compare preoperative characteristics, stroke rates, and mortality between patients with LVEDD above and below the identified cutoff.

Main Methods:

  • Analysis of single-center data from 393 patients who underwent primary HeartMate II implantation between November 2003 and March 2016.
  • Utilized Cox multivariate regression and the Contal and O'Quigley method to determine LVEDD cutoff and its association with mortality.
  • Employed Kaplan-Meier and competing-risk analyses to compare survival and stroke rates based on LVEDD.

Main Results:

  • Low preoperative LVEDD was identified as an independent predictor of mortality (HR, 1.49; P = .02).
  • Patients with LVEDD < 6.0 cm (n=91) exhibited significantly decreased overall survival post-implantation compared to those with LVEDD ≥ 6.0 cm (P = .04).
  • A higher incidence of postoperative stroke was observed in the LVEDD < 6.0 cm group (P < .01).

Conclusions:

  • Preoperative LVEDD < 6.0 cm is associated with reduced overall survival and increased postoperative stroke risk in HeartMate II recipients.
  • Further research is needed to establish LVEDD cutoff values for other mechanical support devices.
  • Future device designs should aim to better accommodate patients with smaller left ventricle sizes.
Abstract

Keywords:
heart failureleft ventricular assist deviceneurological dysfunctionsmall left ventricle

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