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Vascular complications associated with percutaneous left ventricular assist device placement: A 10-year US
Nilay Patel1, Akshit Sharma1, Tarun Dalia1
1Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas.
Insights
Percutaneous left ventricular assist device (p-LVAD) use is rising, but carries a high risk of vascular complications. These complications increase mortality, hospital stay, and costs, necessitating careful consideration during p-LVAD decision-making.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Increasing utilization of percutaneous left ventricular assist devices (p-LVADs) in complex coronary interventions and acute cardiogenic shock.
- Large-bore percutaneous devices are associated with a heightened risk of vascular complications.
Purpose of the Study:
- To examine the incidence and outcomes of vascular complications associated with p-LVAD placement.
- To analyze trends in vascular complication rates using a national inpatient database.
Main Methods:
- Secondary analysis of the National Inpatient Sample (NIS) dataset from 2005-2015.
- Identification of p-LVAD placements using ICD-9-CM codes (37.68, 37.62).
- Statistical comparison of vascular complication rates, mortality, length of stay, and costs.
Main Results:
- A total of 31,263 p-LVAD placements were identified.
- The overall incidence of vascular complications was 13.53%, with 56% requiring surgical intervention.
- Vascular complications were linked to increased in-hospital mortality, longer hospital stays, and higher hospitalization costs.
Conclusions:
- Percutaneous left ventricular assist device placement is associated with a significant rate of vascular complications, often necessitating surgical treatment.
- These complications substantially increase in-hospital mortality, length of stay, and healthcare costs.
- Findings underscore the importance of considering these risks in the clinical decision-making process for p-LVAD implantation.
Background:
Over the last decade, there has been a significant increase in the use of percutaneous left ventricular assist devices(p-LVADs). p-LVADs are being increasingly used during complex coronary interventions and for acute cardiogenic shock. These large bore percutaneous devices have a higher risk of vascular complications. We examined the vascular complication rates from the use of p-LVAD in a national database.
Methods:
We conducted a secondary analysis of the National In-patient Sample (NIS) dataset from 2005 till 2015. We used the ICD-9-CM procedure codes 37.68 and 37.62 for p-LVAD placement regardless of indications. We investigated common vascular complications, defining them by the validated ICD 9 CM codes. χ2 test and t test were used for categorical and continuous variables, respectively for comparison.
Results:
A total of 31,263 p-LVAD placements were identified during the period studied. A majority of patients were male (72.68%) and 64.44% were white. The overall incidence of vascular complications was 13.53%, out of which 56% required surgical treatment. Acute limb thromboembolism and bleeding requiring transfusion accounted for 27.6% and 21.8% of all vascular complications. Occurrence of a vascular complication was associated with significantly higher in-hospital mortality (37.77% vs. 29.95%, p < .001), length of stay (22.7 vs. 12.2 days, p < .001) and cost of hospitalization ($ 161,923 vs. $ 95,547, p < .001).
Conclusions:
There is a high incidence of vascular complications with p-LVAD placement including need for vascular surgery. These complications are associated with a higher in-hospital, LOS and hospitalization costs. These findings should be factored into the decision-making for p-LVAD placement.
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