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7: A Preoperative Clinical Risk Score To Predict Mortality Post-LVAD Implantation
S62
Abstracts
The Journal of Heart and Lung Transplantation February 2008
6
7
Left Ventricular Assist Devices Provide Renal Protection in Patients Awaiting Heart Transplantation S.C. Ennis,2 G.V. Moukarbel,1 T.E. MacGillivray,2 1Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; 2Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
A Preoperative Clinical Risk Score To Predict Mortality PostLVAD Implantation S. Klotz,1 C. Riehl,1 H. Welp,1 J. Sindermann,1 H.H. Scheld,1 1Dept. of Thoracic and Cardiovascular Surgery, University Hospital Muenster, Muenster, Germany
Purpose: Patients with end stage heart failure are often transplanted with declining renal function. We tested the hypothesis that left ventricular assist device (LVAD) as a bridge to transplantation provides renal protection that is sustained in the post transplant period. Methods and Materials: We examined renal function in patients undergoing cardiac transplantation at our center form 7/05 to 3/07, looking at changes in estimated glomerular filtration rate (eGFR) using the MDRD formula (eGFR⫽ 186 x Cr -1.154 x Age -0.203 x 1.21 if Black x 0.742 if Female). Patients were divided into two groups, according to whether or not they received an LVAD: TXP (transplant without LVAD) and VAD TXP (bridged with LVAD to transplant). TXP eGFR was calculated at the time of transplant and at 6 month follow up. VAD TXP eGFR was calculated at the time of LVAD implant, at one month post-implant, at the time of transplant and 6 months follow up. Results: There were 17 patients (13 men) in the VAD TXP group and 16 patients (14 men) in the TXP group. The two groups did not differ with respect to age (49⫾13 vs. 56⫾10 years; p⫽0.08) and eGFR at baseline (54⫾20 vs. 51⫾14 ml/min; p⫽0.6). There was significant improvement in eGFR in the VAD TXP group at one month after implant, at the time of transplantation and at 6 months post transplantation (Figure). There was no change in the eGFR in the TXP group from baseline to 6 months post transplantation. The VAD TXP group had significantly higher eGFR at 6 months post transplantation (78⫾19 vs. 53⫾17 ml/min; p⫽0.0003). Conclusions: LVADs in end stage heart failure provide immediate improvement in renal function that is sustained in the post transplant period. This was not noted in patients who did not receive an LVAD.
Purpose: Background: Mortality following LVAD implantation occurred mainly in the early phase post implantation. We implemented a preoperative risk score to predict mortality on the intensive care unit (ICU). Methods and Materials: 100 preoperative markers were sampled and analyzed (Univariate analysis following multinomial logistic regression) with mortality on the ICU as the primary outcome. Results: Markers were samples in a total of 165 LVAD patients. The mortality rate on the ICU was 36% (n⫽60). Statistical analysis revealed eight significant risk factors for mortality on the ICU (Table). The weighted risk score showed a very good correlation with increasing mortality with each risk score point (Graph). Conclusions: The University of Muenster pre-LVAD risk score is a confident tool to predict mortality on the ICU depending on preoperative variables. Analysis of risk factors for ICU mortality following LVAD implantation (nⴝ165) Patient Characteristics
Odds Ratio (95% CI)
P
Score
Lactate ⬎2.1 mg/dl Arterenol Prior Cardiac Surgery (⬍7 days) On ECMO Support Prior Sternotomy ICM Age ⬎51 years Creatinine ⬎1.6 mg/dl
7.5 (1.7 to 32.7) 3.2 (1.3 to 8.1) 3.0 (1.4 to 6.6) 3.0 (1.2 to 7.4) 2.8 (1.4 to 5.8) 2.7 (1.4 to 5.2) 2.6 (1.4 to 5.0) 2.6 (1.1 to 6.4)
0.003 0.015 0.006 0.021 0.004 0.003 0.004 0.035
7 3 3 3 2 2 2 1
ECMO, extracorporeal circulation; ICM, ischemic cardiomyopathy
8 Can Continuous Flow LVADs Provide a Similar Level of Circulatory Support as Pulsatile LVADs for Large Patients? R. John,1 A.J. Boyle,1 T.E. MacGillivray,2 J.G. Rogers,3 L. Chen,4 D.J. Goldstein,5 W.P. Dembitsky,6 D.J. Farrar,7 F.D. Pagani,8
Abstracts
The Journal of Heart and Lung Transplantation February 2008
6
7
Left Ventricular Assist Devices Provide Renal Protection in Patients Awaiting Heart Transplantation S.C. Ennis,2 G.V. Moukarbel,1 T.E. MacGillivray,2 1Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; 2Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
A Preoperative Clinical Risk Score To Predict Mortality PostLVAD Implantation S. Klotz,1 C. Riehl,1 H. Welp,1 J. Sindermann,1 H.H. Scheld,1 1Dept. of Thoracic and Cardiovascular Surgery, University Hospital Muenster, Muenster, Germany
Purpose: Patients with end stage heart failure are often transplanted with declining renal function. We tested the hypothesis that left ventricular assist device (LVAD) as a bridge to transplantation provides renal protection that is sustained in the post transplant period. Methods and Materials: We examined renal function in patients undergoing cardiac transplantation at our center form 7/05 to 3/07, looking at changes in estimated glomerular filtration rate (eGFR) using the MDRD formula (eGFR⫽ 186 x Cr -1.154 x Age -0.203 x 1.21 if Black x 0.742 if Female). Patients were divided into two groups, according to whether or not they received an LVAD: TXP (transplant without LVAD) and VAD TXP (bridged with LVAD to transplant). TXP eGFR was calculated at the time of transplant and at 6 month follow up. VAD TXP eGFR was calculated at the time of LVAD implant, at one month post-implant, at the time of transplant and 6 months follow up. Results: There were 17 patients (13 men) in the VAD TXP group and 16 patients (14 men) in the TXP group. The two groups did not differ with respect to age (49⫾13 vs. 56⫾10 years; p⫽0.08) and eGFR at baseline (54⫾20 vs. 51⫾14 ml/min; p⫽0.6). There was significant improvement in eGFR in the VAD TXP group at one month after implant, at the time of transplantation and at 6 months post transplantation (Figure). There was no change in the eGFR in the TXP group from baseline to 6 months post transplantation. The VAD TXP group had significantly higher eGFR at 6 months post transplantation (78⫾19 vs. 53⫾17 ml/min; p⫽0.0003). Conclusions: LVADs in end stage heart failure provide immediate improvement in renal function that is sustained in the post transplant period. This was not noted in patients who did not receive an LVAD.
Purpose: Background: Mortality following LVAD implantation occurred mainly in the early phase post implantation. We implemented a preoperative risk score to predict mortality on the intensive care unit (ICU). Methods and Materials: 100 preoperative markers were sampled and analyzed (Univariate analysis following multinomial logistic regression) with mortality on the ICU as the primary outcome. Results: Markers were samples in a total of 165 LVAD patients. The mortality rate on the ICU was 36% (n⫽60). Statistical analysis revealed eight significant risk factors for mortality on the ICU (Table). The weighted risk score showed a very good correlation with increasing mortality with each risk score point (Graph). Conclusions: The University of Muenster pre-LVAD risk score is a confident tool to predict mortality on the ICU depending on preoperative variables. Analysis of risk factors for ICU mortality following LVAD implantation (nⴝ165) Patient Characteristics
Odds Ratio (95% CI)
P
Score
Lactate ⬎2.1 mg/dl Arterenol Prior Cardiac Surgery (⬍7 days) On ECMO Support Prior Sternotomy ICM Age ⬎51 years Creatinine ⬎1.6 mg/dl
7.5 (1.7 to 32.7) 3.2 (1.3 to 8.1) 3.0 (1.4 to 6.6) 3.0 (1.2 to 7.4) 2.8 (1.4 to 5.8) 2.7 (1.4 to 5.2) 2.6 (1.4 to 5.0) 2.6 (1.1 to 6.4)
0.003 0.015 0.006 0.021 0.004 0.003 0.004 0.035
7 3 3 3 2 2 2 1
ECMO, extracorporeal circulation; ICM, ischemic cardiomyopathy
8 Can Continuous Flow LVADs Provide a Similar Level of Circulatory Support as Pulsatile LVADs for Large Patients? R. John,1 A.J. Boyle,1 T.E. MacGillivray,2 J.G. Rogers,3 L. Chen,4 D.J. Goldstein,5 W.P. Dembitsky,6 D.J. Farrar,7 F.D. Pagani,8