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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
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Predictors of in-hospital mortality in patients with left ventricular assist device

Karthik Gonuguntla1, Shivaraj Patil2, Richard Gregory Cowden3

  • 1Department of Internal Medicine and Cardiology, Calhoun Cardiology Center University of Connecticut, Farmington, CT, USA. karthikg.75@gmail.com.

Irish Journal of Medical Science
|May 11, 2020
PubMed

Insights

Continuous flow-left ventricular assist devices (CF-LVADs) have not reduced mortality in end-stage heart failure patients. Increased comorbidities and complications, such as kidney injury and sepsis, predict in-hospital mortality, necessitating improved patient selection for better outcomes.

Area of Science:

  • Cardiology
  • Medical Devices
  • Public Health

Background:

  • Left ventricular assist devices (LVADs) are critical for managing end-stage heart failure.
  • Continuous flow (CF)-LVAD technology represents an advancement in mechanical circulatory support.
  • Understanding factors influencing in-hospital mortality post-LVAD implantation is crucial for patient outcomes.

Purpose of the Study:

  • To evaluate the impact of comorbidities and complications on in-hospital mortality following the introduction of CF-LVADs.
  • To identify key predictors of mortality in patients receiving CF-LVADs.
  • To assess trends in mortality and comorbidity prevalence over a 5-year period.

Main Methods:

  • Utilized the Nationwide Inpatient Sample database from 2010 to 2014.
  • Included 2,359 adult patients (≥18 years) who received an LVAD, identified via ICD-9 codes.
  • Performed comparative and multivariate analyses to determine mortality predictors.

Main Results:

  • In-hospital mortality rates remained consistent between 2010 and 2014.
  • Significant predictors of mortality included hemodialysis, cerebrovascular disease, mechanical ventilation, mild liver disease, and acute kidney injury.
  • Complications such as disseminated intravascular coagulation, sepsis, septic shock, and gastrointestinal bleeding were also associated with increased mortality.

Conclusions:

  • CF-LVADs have not yet demonstrated a reduction in in-hospital mortality, potentially due to their use in patients with significant comorbid conditions.
  • Comorbidities like kidney disease and cerebrovascular disease, along with complications like sepsis, are strong predictors of mortality.
  • Future research should focus on refining patient selection criteria and mitigating post-procedural complications to improve outcomes.
Abstract

Keywords:
End-stage heart failureGI bleedIn-hospital mortalityNISPredictorsSepsis

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