Causes and predictors of early mortality in patients treated with left ventricular assist device implantation in the European Registry of Mechanical Circulatory Support (EUROMACS).
- Akin S Thoraxcenter, Department of Cardiology, Erasmus MC University Medical Centre Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
- Soliman O Department of Cardiology, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Saolta University Healthcare Group, Galway University Road, Galway, Ireland.
- de By TMMH EUROMACS Registry, EACTS, Windsor, UK.
- Muslem R Thoraxcenter, Department of Cardiology, Erasmus MC University Medical Centre Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
- Tijssen JGP Amsterdam University Medical Centers-University of Amsterdam, Amsterdam, The Netherlands.
- Schoenrath F Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, DZHK (German Centre for Cardiovascular Research), Berlin, Germany.
- Meyns B Department of Cardiac Surgery, University Hospital Leuven, University of Leuven, Leuven, Belgium.
- Gummert JF Department for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.
- Mohacsi P Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
- Caliskan K Thoraxcenter, Department of Cardiology, Erasmus MC University Medical Centre Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands. k.caliskan@erasmusmc.nl.
- 2020-02-05
Published in:
- Intensive care medicine. - 2020
English
PURPOSE
The aim of the study was to analyze early mortality after continuous-flow left ventricular assist device (LVAD) implantation which remains high.
METHODS
We analyzed consecutive (n = 2689) patients from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) undergoing continuous-flow LVAD implantation. The primary outcome was early (< 90 days) mortality. Secondary outcomes were differential causes of early post-operative death following LVAD implantation.
RESULTS
Univariable and multivariable analysis as well as regression analysis were used to examine determinants and differential causes of early (< 90 days) mortality after LVAD implantation. During the first 90 days, 2160 (80%) patients were alive with ongoing LVAD support, 40(2%) patients underwent heart transplantation, and 487(18%) deceased. The main causes of early death were MOF (36%), sepsis (28%), cardiopulmonary failure (CPF; 10%), CVA (9%), and right-sided heart failure (RHF, 8%). Furthermore, MOF and sepsis are 70% of causes of death in the first week. Independent clinical predictors of early death were age, female sex, INTERMACS profile 1 to 3, and ECMO. Laboratory predictors included elevated serum creatinine, total bilirubin, lactate, and low hemoglobin. Furthermore, hemodynamic predictors included elevated RA-to-PCWP ratio, pulmonary vascular resistance, and low systemic vascular resistance. Longer total implantation time was also independent predictor of early mortality. A simple model of 12 variables predicts early mortality following LVAD implantation with a good discriminative power with area under the curve of 0.75.
CONCLUSIONS
In the EUROMACS registry, approximately one out of five patients die within 90 days after LVAD implantation. Early mortality is primarily dominated by multiorgan failure followed by sepsis. A simple model identifies important parameters which are associated with early mortality following LVAD implantation.
The aim of the study was to analyze early mortality after continuous-flow left ventricular assist device (LVAD) implantation which remains high.
METHODS
We analyzed consecutive (n = 2689) patients from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) undergoing continuous-flow LVAD implantation. The primary outcome was early (< 90 days) mortality. Secondary outcomes were differential causes of early post-operative death following LVAD implantation.
RESULTS
Univariable and multivariable analysis as well as regression analysis were used to examine determinants and differential causes of early (< 90 days) mortality after LVAD implantation. During the first 90 days, 2160 (80%) patients were alive with ongoing LVAD support, 40(2%) patients underwent heart transplantation, and 487(18%) deceased. The main causes of early death were MOF (36%), sepsis (28%), cardiopulmonary failure (CPF; 10%), CVA (9%), and right-sided heart failure (RHF, 8%). Furthermore, MOF and sepsis are 70% of causes of death in the first week. Independent clinical predictors of early death were age, female sex, INTERMACS profile 1 to 3, and ECMO. Laboratory predictors included elevated serum creatinine, total bilirubin, lactate, and low hemoglobin. Furthermore, hemodynamic predictors included elevated RA-to-PCWP ratio, pulmonary vascular resistance, and low systemic vascular resistance. Longer total implantation time was also independent predictor of early mortality. A simple model of 12 variables predicts early mortality following LVAD implantation with a good discriminative power with area under the curve of 0.75.
CONCLUSIONS
In the EUROMACS registry, approximately one out of five patients die within 90 days after LVAD implantation. Early mortality is primarily dominated by multiorgan failure followed by sepsis. A simple model identifies important parameters which are associated with early mortality following LVAD implantation.
- Language
-
- English
- Open access status
- hybrid
- Identifiers
-
- DOI 10.1007/s00134-020-05939-1
- PMID 32016536
- Persistent URL
- https://folia.unifr.ch/global/documents/30434
Statistics
Document views: 12
File downloads:
- fulltext.pdf: 0