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Impact of Bleeding Revision on Outcomes After Left Ventricular Assist Device Implantation

Philipp Angleitner1, Paul Simon1, Alexandra Kaider2

  • 1Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.

The Annals of Thoracic Surgery
|March 10, 2019
PubMed

Insights

Bleeding revisions after continuous-flow left ventricular assist device (LVAD) implantation significantly reduce survival and increase morbidity. Prophylactic strategies are crucial to prevent this complication in LVAD patients.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Biomedical Engineering

Background:

  • Limited data exists on the impact of bleeding revisions on outcomes following continuous-flow left ventricular assist device (LVAD) implantation.
  • Bleeding complications are a known concern in LVAD recipients.

Purpose of the Study:

  • To investigate the association between bleeding revision and outcomes in adult patients receiving continuous-flow LVADs.
  • To identify risk factors for bleeding revisions in this patient population.

Main Methods:

  • Retrospective analysis of 257 adult continuous-flow LVAD recipients (2006-2016).
  • Primary outcome: survival during LVAD support. Secondary outcomes: prolonged ventilation, ICU/hospital stay, renal replacement therapy, stroke.
  • Multivariable Cox proportional hazards model used to assess survival and identify risk factors for bleeding revision.

Main Results:

  • 14% of patients (36/257) required a bleeding revision.
  • Bleeding revision was significantly associated with reduced survival during LVAD support (p=0.007).
  • Patients undergoing bleeding revision had substantially higher rates of secondary adverse outcomes. Concomitant RVAD implantation and older age were independent risk factors for bleeding revision.

Conclusions:

  • Bleeding revision is a significant adverse event associated with reduced survival and increased morbidity in LVAD patients.
  • Prophylactic measures, implemented pre-, intra-, and postoperatively, may help mitigate the risk of bleeding complications.
Abstract

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