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Arrhythmia History Predicts Morbidity and Mortality Following LVAD Implantation
S378
The Journal of Heart and Lung Transplantation, Vol 35, No 4S, April 2016
target vessel. Cardiogenic shock developed in ECMO group at mean 1.2 days, and 1.4 days in No-ECMO group without statistically significant difference. ECMO application was performed at 0.4 days from cardiogenic shock. Crude in-hospital mortality rate was significantly higher in ECMO group (81.7% vs. 35.5%, p< 0.0001) compared to the NO-ECMO group. However, there was no statistical difference after propensity score matching in in-hospital mortality (76% in ECMO group vs. 52% in No-ECMO group, p= 0.08). ECMO was not a significant predictor for in-hospital mortality after matching (OR 1.505, 95% CI 0.907-2.498, p= 0.11). Within ECMO subgroup, early insertion of ECMO within admission day, co-treatment with IABP, and no CPR were associated with in-hospital survival. Conclusion: Among acute myocardial infarction patients complicated with cardiogenic shock, open use of ECMO was not associated with increased in-hospital mortality. Timely approach of ECMO might augment its beneficial effect.
Incidence Rate Ratios Associated with Non-Compliance
Infection Bleeding Renal Failure Stroke Right Ventricular Failure Cardiovascular Dysfunction Mechanical Malfunction Hemolysis
IRR
95% CI
P-Value
1.13 1.41 0.9 0.62 1.67 0.53 2.13 0.91
(0.62, 2.03) (0.62, 3.16) (0.17, 4.55) (0.19, 1.97) (0.29, 9.60) (0.19, 1.45) (0.80, 5.62) (0.10, 4.54)
0.683 0.409 0.897 0.413 0.566 0.215 0.126 0.907
1( 057) Arrhythmia History Predicts Morbidity and Mortality Following LVAD Implantation A.R. Garan ,1 V.K. Topkara,1 X. Mai,1 B.C. Varr,1 K. Wong,1 F. Castagna,1 P.N. Trinh,2 S. Sreekanth,3 M. Tiburcio,3 M. Flannery,3 D.L. Jennings,1 K. Takeda,3 H. Takayama,3 Y. Naka,3 M. Maurer,1 D.M. Mancini,1 M. Yuzefpolskaya,1 W. Whang,1 P.C. Colombo.1 1Medicine, Columbia University, New York, NY; 2Epidemiology, Columbia University, New York, NY; 3Surgery, Columbia University, New York, NY.
1( 056) Characteristics of Non-Compliant (NC) LVAD Patients J. Larsen ,1 E.M. Dunn,2 N.M. Kunz,2 K.L. Lockard,2 J.J. Teuteberg,2 L. Lagazzi,2 A.D. Althouse,2 R.L. Kormos.2 1University of Pittsburgh School of Medicine, Pittsburgh, PA; 2The Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA. Purpose: Patients living at home after receiving an LVAD must follow a prescribed regimen of LVAD care with careful follow-up. Although NC is a recognized issue, little is known about the characteristics of patients exhibiting poor compliance with LVAD therapy. Methods: All patients implanted with a continuous-flow LVAD from 04/2004 to 01/2015 who were discharged home after implant were included in the analysis. NC events were prospectively recorded. Events included failure with follow-up appointments, not obtaining blood work or taking prescribed medications, substance abuse, poor LVAD pump care, and not responding to phone calls. Patients were labeled NC if they exhibited one or more NC event. Patient characteristics were compared between compliant and NC patients. Results: 135 patients were discharged with a device. Of those, 32 patients (23.7%) were NC at least once during follow-up. Failure to get required blood work accounted for 40% of episodes, failing to comply with medications for 27%, poor communication for 21%, and not following care plan for 12%. Patient characteristics associated with higher likelihood of NC were total time on device (39.4% for > 12 months vs. 18.5% for 6-12 months vs. 2.4% for 0-6 months, p< 0.001), device strategy (42.1% for destination therapy vs. 10.4% for bridge-to-transplant), diabetes (37.7% vs. 14.6%, p= 0.002), and hypertension (28.7% vs. 14.6%, p= 0.064). NC was associated with a slightly increased risk of mechanical malfunction (IRR= 2.13, p= 0.126) but not with increased risk of any other adverse events (Table 1), although statistical power to detect these relationships was limited. Conclusion: Patient characteristics associated with a higher likelihood of exhibiting NC were time on device, a destination therapy device strategy, diabetes, and hypertension. It is yet unclear how non-compliance with LVAD therapy impacts survival or adverse events. Patients who may have a higher likelihood of poor compliance may require further supportive measures to improve compliance, and thereby improve outcomes.
Purpose: Ventricular arrhythmia (VA) is common in patients with advanced heart failure. Often the occurrence of VA prompts consideration for left ventricular assist device (LVAD) implantation. Whether patients with VA occurring immediately prior to LVAD insertion have similar outcomes to those who do not is not known. Methods: We performed a retrospective analysis of all patients receiving a continuous-flow LVAD at our institution between 5/1/2004 and 10/1/2014. Patients were excluded if a detailed VA history was not available. Patients were divided into two groups: those having suffered VA in the month prior to LVAD implant and those who did not. The primary outcome was a composite of all-cause mortality and CV readmission not related to pump malfunction. Results: Three-hundred and forty-three patients received a continuous-flow LVAD during this time period. Detailed VA history was available for 288 patients. Seventy-four (25.7%) had experienced VA in the month prior to LVAD implant whereas only 34 (11.8%) had experienced VA in the 2 months prior to that. The average age was 58.3 ± 13.7 years, 47.6% had an ischemic cardiomyopathy, and 79.5% were men. Age, cardiomyopathy type, gender distribution, and prevalence of an ICD were similar between the two groups. After adjusting for covariates patients with VA in the month prior to LVAD implant had increased risk of the primary outcome (HR 1.82; 95% CI 1.04 - 3.19; figure). Conclusion: The rate of VA increases by more 100% in the month prior to LVAD implantation and often prompts consideration of LVAD therapy. VA in the month prior to LVAD insertion predicts worse mortality and CV readmission rate. Whether anti-arrhythmic management can reduce this risk remains to be studied.
Abstracts S379 1( 058) QRS Duration Predicts Outcomes Following Implantation of a Left Ventricular Assist Device A.R. Garan ,1 X. Mai,1 V.K. Topkara,1 K.J. Clerkin,1 K. Wong,1 F. Castagna,1 P.N. Trinh,2 S. Sreekanth,3 D.L. Jennings,1 M.F. Torres,3 B. Cagliostro,3 G. Parkis,3 K. Takeda,3 H. Takayama,3 Y. Naka,3 M. Maurer,1 D.M. Mancini,1 M. Yuzefpolskaya,1 J.M. Dizon,1 P.C. Colombo.1 1Medicine, Columbia University, New York, NY; 2Epidemiology, Columbia University, New York, NY; 3Surgery, Columbia University, New York, NY. Purpose: Increased QRS duration correlates with worse outcomes in patients with chronic heart failure. Cardiac resynchronization therapy (CRT) reduces mortality and cardiovascular (CV) readmissions in selected patients with wide QRS. Whether QRS duration predicts outcomes in patients supported by continuous-flow (CF) left ventricular assist device (LVAD) is unknown. Methods: We performed a retrospective analysis of all patients receiving a continuous-flow LVAD at our institution between 5/1/2004 and 10/1/2014. Patients who had pre-existing CRT were excluded from analysis. The primary outcome was a composite of all-cause mortality and CV readmissions not related to pump malfunction. Patients were classified as having shorter or longer QRS duration based on an ECG at the time of LVAD implantation. Results: Three-hundred and forty-three patients received a continuous-flow LVAD during this time period. 190 (55.4%) patients who did not have CRT were included in the analysis. Forty-nine (25.8%) patients without CRT had a QRS duration ≥ 150msec and 141 (74.2%) had a QRS < 150msec. The average age was 55.5 ± 14.3 years, 50.5% had an ischemic cardiomyopathy, and 76.8% were men. Cardiomyopathy type, gender distribution, and prevalence of diabetes were similar in the two groups. Patients with shorter QRS duration were younger than those with a wide QRS (54.0 ± 14.6 vs. 59.9 ± 12.5; p= 0.04). After adjustment for age and type of cardiomyopathy, patients with longer QRS duration were at higher risk for the composite outcome (HR 2.58; 95% CI 1.27 - 5.23; figure). Conclusion: Longer QRS duration predicts worse mortality and CV readmission rate following LVAD implantation. Whether CRT can improve this outcome in LVAD recipients remains to be investigated.
1( 059) LVAD Implantation in Cardiogenic Shock: Improved Outcome by Less Invasive Surgery S.V. Rojas , M. Avsar, M. Hillert, J.S. Hanke, A. Uribarri, K. Tuemler, C. Kuehn, A. Haverich, J.D. Schmitto. Department of Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany. Purpose: In cardiogenic shock, left ventricular assist device implantation (LVAD) is considered as rescue therapy and associated with high mortality rates. Moreover, standard LVAD implantation techniques can implicate severe complications like bleeding or right heart failure. The aim of our study was to assess the outcome of “crash and burn” patients receiving a LVAD by standard or less invasive surgery. Methods: We performed a prospective evaluation the early outcome of 46 consecutive heart failure patients in cardiogenic shock, who underwent LVAD
(HVAD, HeartWare International, Framingham, USA) implantation in our institution between 2012 and 2014. A total of 20 patients (Group A) were implanted by full sternotomy. In contrast 26 patients were operated by a less invasive technique (upper hemisternotomy and a left-sided anterolateral thoracotomy) (Group B). The primary endpoint was survival after 6 months without device-related re-operations. Secondary endpoints included a composite (MACE) of the rate of right heart failure (RHF), respiratory failure, bleeding, sepsis, renal dysfunction, and stroke during the same period. Results: Baseline characteristics were similar in both groups. Survival after 30 days was higher in group B (0.69 vs. 0.65; p = 0.76). Total ICU stay was lower in less-invasive patients (15.0±11.2 vs. 23.0±17.3; p = 0.06). Incidence of MACE was lower in the less-invasive group (0.75 vs. 0.58; p 0 0.22), including improvements in right heart failure (0.60 vs 0.31; p < 0.5) and incidence of post-operative bleeding requiring surgery (0.15 vs. 0.08; p = 0.43). Conclusion: LVAD implantation in crash and burn patients is considered as high risk procedure independent of the implantation technique. However, our study indicates that less invasive LVAD implantation in cardiogenic shock decreases the incidence of postoperative adverse events. 1( 060) Impact of Preoperative Variables on Hospital Length of Stay in Patients Undergoing Continuous Flow LVAD Implantation D. Plack ,1 S.S. Roy,2 R. Cogswell,2 J. Spratt,1 K. Liao,1 R. John.1 1Department of Cardiothoracic Surgery, University of Minnesota Medical School, Minneapolis, MN; 2Department of Cardiology, University of Minnesota Medical School, Minneapolis, MN. Purpose: Understanding which pre-operative factors predict a longer length of stay (LOS) after left ventricular assist device (LVAD) is important for preoperative patient counseling and for understanding the impact of LVADs on inpatient resource utilization. It is also unknown whether increased LOS is associated with increased post LVAD mortality. Methods: In this single-center retrospective analysis, we evaluated 303 consecutive patients who underwent continuous flow LVAD placements from June 2005 through October 2015. We censored 26 patients that died prior to hospital discharge at the time of death. The remaining 277 patients were divided into two groups based on LOS (< 21 days and ≥ 21 days). The 21 day cut point was chosen as this was an even number at the 75 % percentile. A multivariable logistic regression was used to assess for predictors of increased LOS and a multivariable cox regression was performed to examine the impact of LOS on long term survival. Cohort subjects were censored at the time of transplant. Results: The mean age of the cohort was 57 years (+/- 14 yrs.), 221 (79.8%) were male and 215 (78.2%) were bridge to transplant (BTT). The median LOS was 16 days (IQR 12-22 days). In the final adjusted models, significant predictors of increased LOS included lower INTERMACS score (OR= 0.79; 95% CI: 0.64-0.99) and chronic kidney disease (CKD) (OR= 2.02; 95% CI: 1.02-3.99). Patients with a LOS ≥ 21 days had an increased hazards rate of death during follow up compared to patients with a LOS < 21 days, even after adjustment for other risk factors for mortality (HR= 1.84; 95% CI: 1.06-3.17). Conclusion: Pre-operative risk factors for increased LOS after LVAD implantation include a lower INTERMACS score and CKD. Increased LOS was associated with a worsened survival after LVAD even after adjustment for other pre-operative risk factors for increased mortality.
Pre-operative patient characteristics by length of inpatient stay after LVAD implantation Variable n (%)
LOS < 21 days (n= 195)
LOS > = 21 days (n= 82)
p-value
Age (mean ± SD) Sex (male) INTERMACS (med, IQR) BMI BTT Hypertension Diabetes COPD Prior MI CKD CAD CABG
58 ± 14 160 (82.1) 4 [3,5] 28.7 ± 5.3 155 (80.3) 81 (44.5) 66 (36.3) 18 (9.9) 81 (44.8) 59 (32.2) 115 (63.2) 59 (30.7)
56 ± 15 61 (74.4) 3 [2,4] 28.7 ± 6.4 60 (73.2) 33 (47.1) 29 (41.4) 16 (23.2) 32 (45.7) 33 (47.8) 43 (61.4) 22 (27.2)
0.53 0.15 < 0.01 0.96 0.19 0.71 0.45 < 0.01 0.89 < 0.05 0.8 0.56
The Journal of Heart and Lung Transplantation, Vol 35, No 4S, April 2016
target vessel. Cardiogenic shock developed in ECMO group at mean 1.2 days, and 1.4 days in No-ECMO group without statistically significant difference. ECMO application was performed at 0.4 days from cardiogenic shock. Crude in-hospital mortality rate was significantly higher in ECMO group (81.7% vs. 35.5%, p< 0.0001) compared to the NO-ECMO group. However, there was no statistical difference after propensity score matching in in-hospital mortality (76% in ECMO group vs. 52% in No-ECMO group, p= 0.08). ECMO was not a significant predictor for in-hospital mortality after matching (OR 1.505, 95% CI 0.907-2.498, p= 0.11). Within ECMO subgroup, early insertion of ECMO within admission day, co-treatment with IABP, and no CPR were associated with in-hospital survival. Conclusion: Among acute myocardial infarction patients complicated with cardiogenic shock, open use of ECMO was not associated with increased in-hospital mortality. Timely approach of ECMO might augment its beneficial effect.
Incidence Rate Ratios Associated with Non-Compliance
Infection Bleeding Renal Failure Stroke Right Ventricular Failure Cardiovascular Dysfunction Mechanical Malfunction Hemolysis
IRR
95% CI
P-Value
1.13 1.41 0.9 0.62 1.67 0.53 2.13 0.91
(0.62, 2.03) (0.62, 3.16) (0.17, 4.55) (0.19, 1.97) (0.29, 9.60) (0.19, 1.45) (0.80, 5.62) (0.10, 4.54)
0.683 0.409 0.897 0.413 0.566 0.215 0.126 0.907
1( 057) Arrhythmia History Predicts Morbidity and Mortality Following LVAD Implantation A.R. Garan ,1 V.K. Topkara,1 X. Mai,1 B.C. Varr,1 K. Wong,1 F. Castagna,1 P.N. Trinh,2 S. Sreekanth,3 M. Tiburcio,3 M. Flannery,3 D.L. Jennings,1 K. Takeda,3 H. Takayama,3 Y. Naka,3 M. Maurer,1 D.M. Mancini,1 M. Yuzefpolskaya,1 W. Whang,1 P.C. Colombo.1 1Medicine, Columbia University, New York, NY; 2Epidemiology, Columbia University, New York, NY; 3Surgery, Columbia University, New York, NY.
1( 056) Characteristics of Non-Compliant (NC) LVAD Patients J. Larsen ,1 E.M. Dunn,2 N.M. Kunz,2 K.L. Lockard,2 J.J. Teuteberg,2 L. Lagazzi,2 A.D. Althouse,2 R.L. Kormos.2 1University of Pittsburgh School of Medicine, Pittsburgh, PA; 2The Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA. Purpose: Patients living at home after receiving an LVAD must follow a prescribed regimen of LVAD care with careful follow-up. Although NC is a recognized issue, little is known about the characteristics of patients exhibiting poor compliance with LVAD therapy. Methods: All patients implanted with a continuous-flow LVAD from 04/2004 to 01/2015 who were discharged home after implant were included in the analysis. NC events were prospectively recorded. Events included failure with follow-up appointments, not obtaining blood work or taking prescribed medications, substance abuse, poor LVAD pump care, and not responding to phone calls. Patients were labeled NC if they exhibited one or more NC event. Patient characteristics were compared between compliant and NC patients. Results: 135 patients were discharged with a device. Of those, 32 patients (23.7%) were NC at least once during follow-up. Failure to get required blood work accounted for 40% of episodes, failing to comply with medications for 27%, poor communication for 21%, and not following care plan for 12%. Patient characteristics associated with higher likelihood of NC were total time on device (39.4% for > 12 months vs. 18.5% for 6-12 months vs. 2.4% for 0-6 months, p< 0.001), device strategy (42.1% for destination therapy vs. 10.4% for bridge-to-transplant), diabetes (37.7% vs. 14.6%, p= 0.002), and hypertension (28.7% vs. 14.6%, p= 0.064). NC was associated with a slightly increased risk of mechanical malfunction (IRR= 2.13, p= 0.126) but not with increased risk of any other adverse events (Table 1), although statistical power to detect these relationships was limited. Conclusion: Patient characteristics associated with a higher likelihood of exhibiting NC were time on device, a destination therapy device strategy, diabetes, and hypertension. It is yet unclear how non-compliance with LVAD therapy impacts survival or adverse events. Patients who may have a higher likelihood of poor compliance may require further supportive measures to improve compliance, and thereby improve outcomes.
Purpose: Ventricular arrhythmia (VA) is common in patients with advanced heart failure. Often the occurrence of VA prompts consideration for left ventricular assist device (LVAD) implantation. Whether patients with VA occurring immediately prior to LVAD insertion have similar outcomes to those who do not is not known. Methods: We performed a retrospective analysis of all patients receiving a continuous-flow LVAD at our institution between 5/1/2004 and 10/1/2014. Patients were excluded if a detailed VA history was not available. Patients were divided into two groups: those having suffered VA in the month prior to LVAD implant and those who did not. The primary outcome was a composite of all-cause mortality and CV readmission not related to pump malfunction. Results: Three-hundred and forty-three patients received a continuous-flow LVAD during this time period. Detailed VA history was available for 288 patients. Seventy-four (25.7%) had experienced VA in the month prior to LVAD implant whereas only 34 (11.8%) had experienced VA in the 2 months prior to that. The average age was 58.3 ± 13.7 years, 47.6% had an ischemic cardiomyopathy, and 79.5% were men. Age, cardiomyopathy type, gender distribution, and prevalence of an ICD were similar between the two groups. After adjusting for covariates patients with VA in the month prior to LVAD implant had increased risk of the primary outcome (HR 1.82; 95% CI 1.04 - 3.19; figure). Conclusion: The rate of VA increases by more 100% in the month prior to LVAD implantation and often prompts consideration of LVAD therapy. VA in the month prior to LVAD insertion predicts worse mortality and CV readmission rate. Whether anti-arrhythmic management can reduce this risk remains to be studied.
Abstracts S379 1( 058) QRS Duration Predicts Outcomes Following Implantation of a Left Ventricular Assist Device A.R. Garan ,1 X. Mai,1 V.K. Topkara,1 K.J. Clerkin,1 K. Wong,1 F. Castagna,1 P.N. Trinh,2 S. Sreekanth,3 D.L. Jennings,1 M.F. Torres,3 B. Cagliostro,3 G. Parkis,3 K. Takeda,3 H. Takayama,3 Y. Naka,3 M. Maurer,1 D.M. Mancini,1 M. Yuzefpolskaya,1 J.M. Dizon,1 P.C. Colombo.1 1Medicine, Columbia University, New York, NY; 2Epidemiology, Columbia University, New York, NY; 3Surgery, Columbia University, New York, NY. Purpose: Increased QRS duration correlates with worse outcomes in patients with chronic heart failure. Cardiac resynchronization therapy (CRT) reduces mortality and cardiovascular (CV) readmissions in selected patients with wide QRS. Whether QRS duration predicts outcomes in patients supported by continuous-flow (CF) left ventricular assist device (LVAD) is unknown. Methods: We performed a retrospective analysis of all patients receiving a continuous-flow LVAD at our institution between 5/1/2004 and 10/1/2014. Patients who had pre-existing CRT were excluded from analysis. The primary outcome was a composite of all-cause mortality and CV readmissions not related to pump malfunction. Patients were classified as having shorter or longer QRS duration based on an ECG at the time of LVAD implantation. Results: Three-hundred and forty-three patients received a continuous-flow LVAD during this time period. 190 (55.4%) patients who did not have CRT were included in the analysis. Forty-nine (25.8%) patients without CRT had a QRS duration ≥ 150msec and 141 (74.2%) had a QRS < 150msec. The average age was 55.5 ± 14.3 years, 50.5% had an ischemic cardiomyopathy, and 76.8% were men. Cardiomyopathy type, gender distribution, and prevalence of diabetes were similar in the two groups. Patients with shorter QRS duration were younger than those with a wide QRS (54.0 ± 14.6 vs. 59.9 ± 12.5; p= 0.04). After adjustment for age and type of cardiomyopathy, patients with longer QRS duration were at higher risk for the composite outcome (HR 2.58; 95% CI 1.27 - 5.23; figure). Conclusion: Longer QRS duration predicts worse mortality and CV readmission rate following LVAD implantation. Whether CRT can improve this outcome in LVAD recipients remains to be investigated.
1( 059) LVAD Implantation in Cardiogenic Shock: Improved Outcome by Less Invasive Surgery S.V. Rojas , M. Avsar, M. Hillert, J.S. Hanke, A. Uribarri, K. Tuemler, C. Kuehn, A. Haverich, J.D. Schmitto. Department of Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany. Purpose: In cardiogenic shock, left ventricular assist device implantation (LVAD) is considered as rescue therapy and associated with high mortality rates. Moreover, standard LVAD implantation techniques can implicate severe complications like bleeding or right heart failure. The aim of our study was to assess the outcome of “crash and burn” patients receiving a LVAD by standard or less invasive surgery. Methods: We performed a prospective evaluation the early outcome of 46 consecutive heart failure patients in cardiogenic shock, who underwent LVAD
(HVAD, HeartWare International, Framingham, USA) implantation in our institution between 2012 and 2014. A total of 20 patients (Group A) were implanted by full sternotomy. In contrast 26 patients were operated by a less invasive technique (upper hemisternotomy and a left-sided anterolateral thoracotomy) (Group B). The primary endpoint was survival after 6 months without device-related re-operations. Secondary endpoints included a composite (MACE) of the rate of right heart failure (RHF), respiratory failure, bleeding, sepsis, renal dysfunction, and stroke during the same period. Results: Baseline characteristics were similar in both groups. Survival after 30 days was higher in group B (0.69 vs. 0.65; p = 0.76). Total ICU stay was lower in less-invasive patients (15.0±11.2 vs. 23.0±17.3; p = 0.06). Incidence of MACE was lower in the less-invasive group (0.75 vs. 0.58; p 0 0.22), including improvements in right heart failure (0.60 vs 0.31; p < 0.5) and incidence of post-operative bleeding requiring surgery (0.15 vs. 0.08; p = 0.43). Conclusion: LVAD implantation in crash and burn patients is considered as high risk procedure independent of the implantation technique. However, our study indicates that less invasive LVAD implantation in cardiogenic shock decreases the incidence of postoperative adverse events. 1( 060) Impact of Preoperative Variables on Hospital Length of Stay in Patients Undergoing Continuous Flow LVAD Implantation D. Plack ,1 S.S. Roy,2 R. Cogswell,2 J. Spratt,1 K. Liao,1 R. John.1 1Department of Cardiothoracic Surgery, University of Minnesota Medical School, Minneapolis, MN; 2Department of Cardiology, University of Minnesota Medical School, Minneapolis, MN. Purpose: Understanding which pre-operative factors predict a longer length of stay (LOS) after left ventricular assist device (LVAD) is important for preoperative patient counseling and for understanding the impact of LVADs on inpatient resource utilization. It is also unknown whether increased LOS is associated with increased post LVAD mortality. Methods: In this single-center retrospective analysis, we evaluated 303 consecutive patients who underwent continuous flow LVAD placements from June 2005 through October 2015. We censored 26 patients that died prior to hospital discharge at the time of death. The remaining 277 patients were divided into two groups based on LOS (< 21 days and ≥ 21 days). The 21 day cut point was chosen as this was an even number at the 75 % percentile. A multivariable logistic regression was used to assess for predictors of increased LOS and a multivariable cox regression was performed to examine the impact of LOS on long term survival. Cohort subjects were censored at the time of transplant. Results: The mean age of the cohort was 57 years (+/- 14 yrs.), 221 (79.8%) were male and 215 (78.2%) were bridge to transplant (BTT). The median LOS was 16 days (IQR 12-22 days). In the final adjusted models, significant predictors of increased LOS included lower INTERMACS score (OR= 0.79; 95% CI: 0.64-0.99) and chronic kidney disease (CKD) (OR= 2.02; 95% CI: 1.02-3.99). Patients with a LOS ≥ 21 days had an increased hazards rate of death during follow up compared to patients with a LOS < 21 days, even after adjustment for other risk factors for mortality (HR= 1.84; 95% CI: 1.06-3.17). Conclusion: Pre-operative risk factors for increased LOS after LVAD implantation include a lower INTERMACS score and CKD. Increased LOS was associated with a worsened survival after LVAD even after adjustment for other pre-operative risk factors for increased mortality.
Pre-operative patient characteristics by length of inpatient stay after LVAD implantation Variable n (%)
LOS < 21 days (n= 195)
LOS > = 21 days (n= 82)
p-value
Age (mean ± SD) Sex (male) INTERMACS (med, IQR) BMI BTT Hypertension Diabetes COPD Prior MI CKD CAD CABG
58 ± 14 160 (82.1) 4 [3,5] 28.7 ± 5.3 155 (80.3) 81 (44.5) 66 (36.3) 18 (9.9) 81 (44.8) 59 (32.2) 115 (63.2) 59 (30.7)
56 ± 15 61 (74.4) 3 [2,4] 28.7 ± 6.4 60 (73.2) 33 (47.1) 29 (41.4) 16 (23.2) 32 (45.7) 33 (47.8) 43 (61.4) 22 (27.2)
0.53 0.15 < 0.01 0.96 0.19 0.71 0.45 < 0.01 0.89 < 0.05 0.8 0.56