Relationship of PAD and Use of TMCS on Outcomes Post-LVAD: A Case Series of 197 Patients

As left ventricular assist device (LVAD) use expands to include more critically ill patients, identifying and mitigating preoperative risk factors, such as peripheral arterial disease (PAD) and use of temporary mechanical circulatory support (tMCS) essential. This retrospective cohort study included patients who underwent HeartMate 3 (HM3) implantation from 2015 to 2023. Patients were divided into those with severe PAD and those without as well as the use of tMCS. The primary outcome was the incidence of vascular complications, defined as the development of dry gangrene, need for lower extremity amputation, or revascularization. Secondary outcomes included stroke, renal failure, death during implant hospitalization, and overall survival. Of the 197 patients who underwent HM3 implantation, 22 (11%) were identified as having severe PAD sonographically. Vascular complications were significantly more common in patients with severe PAD (23% vs. 4%, p = 0.005). There were no significant differences in other complications such as renal failure, stroke, or death during implant hospitalization. Multivariable unadjusted analysis revealed that both PAD, postoperative tMCS, and femoral cannulation site independently increased the odds of vascular complications, whereas in the adjusted model preoperative tMCS was associated with vascular complications. These findings underscore the importance of preoperative risk stratification and tailored perioperative management.