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Impact of either short- or long-term right heart support on continuous flow LVAD outcomes
Abstract
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229 Impact of either short- or long-term right heart support on continuous flow LVAD outcomes S. Rao 1,∗ , S. Shehab 2 , J. Lewis 3 , K. De Silva 3 , R. Desiree 1 , M. Connellan 1 , P. Macdonald 1,4 , A. Keogh 1 , A. Jabbour 1,4 , E. Kotlyar 1 , E. Granger 1 , P. Spratt 1 , K. Dhital 1 , P. Jansz 1 , C. Hayward 1,4 1 St
Vincent’s Hospital, Sydney, Australia 2 Univerity of Technology Sydney, Australia 3 University of New South Wales, Australia 4 Victor Chang Cardiac Research Institute, Sydney, Australia Background: Left ventricular assist device (LVAD) use in end stage cardiac failure is routine therapy. Veno-pulmonary artery extracorporeal membrane oxygenation (VPA-ECMO) and BiVADs are used for right ventricular (RV) support. We compared outcomes in LVAD alone patients to those requiring either form of RV support. Methods: Data were analysed for 125 continuous flow LVAD patients (2004–2015, 98 male), including 22 patients requiring VPA-ECMO support and 13 needing BiVAD. Data gathered included demographics, INTERMACS level, post-operative length of stay (LoS) and mortality or transplantation date. Results: Median post-operative ICU LoS for LVAD, VPAECMO and BiVAD groups was 7, 20 and 15 days (p ≤ 0.01, LVAD vs other groups; p = ns, VPA-ECMO vs BiVAD) and median hospital LoS 45, 59 and 64 days respectively. Thirtyday survival was 99%, 86%, and 100% for LVAD, VPA-ECMO and BiVAD groups, while three-year survival or survival-totransplant rates were 74%, 50% and 51% (p < 0.01, LVAD vs other groups; p = ns, VPA-ECMO vs BiVAD).
Conclusion: Overall prognosis remains poor for those requiring any RV support compared to LVAD support alone. In those who required RV support, the use of VPA-ECMO results in longer ICU stay and worse short-term outcomes than those with BiVAD support. However if supported through the initial phase, long-term outcomes are similar for both groups. http://dx.doi.org/10.1016/j.hlc.2015.06.230
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230 Impact of left ventricular function on outcomes following percutaneous coronary intervention L. Selkrig 1,∗ , N. Andrianopoulos 2 , S. Nanayakkara 1 , H. Krum 2 , A. Dart 1 , D. Clark 3 , A. Brennan 2 , J. Shaw 1 , A. Ajani 4 , G. New 5 , C. Hiew 6 , S. Duffy 1 1 Alfred
Health, Australia University CCRET- Centre of Cardiovascular Research and Education in Therapeutics, Australia 3 Austin Health, Australia 4 Royal Melbourne Hospital, Australia 5 Boxhill Hospital, Australia 6 University Hospital, Geelong, Australia 2 Monash
Background: Left ventricular ejection fraction (LVEF) is an established predictor of early mortality in patients undergoing PCI. We aimed to determine the association between LVEF and short- and long-term morbidity and mortality in patients undergoing PCI.
Methods and Results: We analysed the outcomes of 17,232 patients with LVEF recorded (87% of 19,844 cases) who underwent PCI from 2005-2013 within the Melbourne Interventional Group registry, comparing patients by categories of LVEF (see Figure). Forty per cent of patients had impaired LVEF. Patients with reduced LVEF were older, and more likely to have diabetes, atrial fibrillation, multivessel disease, prior MI or CABG, renal impairment, cerebrovascular and peripheral vascular disease (all P<0.001). Reduced LVEF was associated with all traditional inpatient and 12-month major adverse cardiac events (P<0.001). Thirty-day, 12-month and long-term mortality was higher in patients with reduced LVEF (P<0.001; see Figure). Appropriate heart failure therapy was significantly greater in each grade of LV dysfunction and was used in >80% of patients with moderate or severely reduced LVEF. Impaired LVEF was an independent predictor of mortality. Conclusions: Left ventricular dysfunction is a strong, independent predictor of morbidity and mortality in patients undergoing PCI despite appropriate adjunctive medical therapy. http://dx.doi.org/10.1016/j.hlc.2015.06.231
S208
229 Impact of either short- or long-term right heart support on continuous flow LVAD outcomes S. Rao 1,∗ , S. Shehab 2 , J. Lewis 3 , K. De Silva 3 , R. Desiree 1 , M. Connellan 1 , P. Macdonald 1,4 , A. Keogh 1 , A. Jabbour 1,4 , E. Kotlyar 1 , E. Granger 1 , P. Spratt 1 , K. Dhital 1 , P. Jansz 1 , C. Hayward 1,4 1 St
Vincent’s Hospital, Sydney, Australia 2 Univerity of Technology Sydney, Australia 3 University of New South Wales, Australia 4 Victor Chang Cardiac Research Institute, Sydney, Australia Background: Left ventricular assist device (LVAD) use in end stage cardiac failure is routine therapy. Veno-pulmonary artery extracorporeal membrane oxygenation (VPA-ECMO) and BiVADs are used for right ventricular (RV) support. We compared outcomes in LVAD alone patients to those requiring either form of RV support. Methods: Data were analysed for 125 continuous flow LVAD patients (2004–2015, 98 male), including 22 patients requiring VPA-ECMO support and 13 needing BiVAD. Data gathered included demographics, INTERMACS level, post-operative length of stay (LoS) and mortality or transplantation date. Results: Median post-operative ICU LoS for LVAD, VPAECMO and BiVAD groups was 7, 20 and 15 days (p ≤ 0.01, LVAD vs other groups; p = ns, VPA-ECMO vs BiVAD) and median hospital LoS 45, 59 and 64 days respectively. Thirtyday survival was 99%, 86%, and 100% for LVAD, VPA-ECMO and BiVAD groups, while three-year survival or survival-totransplant rates were 74%, 50% and 51% (p < 0.01, LVAD vs other groups; p = ns, VPA-ECMO vs BiVAD).
Conclusion: Overall prognosis remains poor for those requiring any RV support compared to LVAD support alone. In those who required RV support, the use of VPA-ECMO results in longer ICU stay and worse short-term outcomes than those with BiVAD support. However if supported through the initial phase, long-term outcomes are similar for both groups. http://dx.doi.org/10.1016/j.hlc.2015.06.230
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230 Impact of left ventricular function on outcomes following percutaneous coronary intervention L. Selkrig 1,∗ , N. Andrianopoulos 2 , S. Nanayakkara 1 , H. Krum 2 , A. Dart 1 , D. Clark 3 , A. Brennan 2 , J. Shaw 1 , A. Ajani 4 , G. New 5 , C. Hiew 6 , S. Duffy 1 1 Alfred
Health, Australia University CCRET- Centre of Cardiovascular Research and Education in Therapeutics, Australia 3 Austin Health, Australia 4 Royal Melbourne Hospital, Australia 5 Boxhill Hospital, Australia 6 University Hospital, Geelong, Australia 2 Monash
Background: Left ventricular ejection fraction (LVEF) is an established predictor of early mortality in patients undergoing PCI. We aimed to determine the association between LVEF and short- and long-term morbidity and mortality in patients undergoing PCI.
Methods and Results: We analysed the outcomes of 17,232 patients with LVEF recorded (87% of 19,844 cases) who underwent PCI from 2005-2013 within the Melbourne Interventional Group registry, comparing patients by categories of LVEF (see Figure). Forty per cent of patients had impaired LVEF. Patients with reduced LVEF were older, and more likely to have diabetes, atrial fibrillation, multivessel disease, prior MI or CABG, renal impairment, cerebrovascular and peripheral vascular disease (all P<0.001). Reduced LVEF was associated with all traditional inpatient and 12-month major adverse cardiac events (P<0.001). Thirty-day, 12-month and long-term mortality was higher in patients with reduced LVEF (P<0.001; see Figure). Appropriate heart failure therapy was significantly greater in each grade of LV dysfunction and was used in >80% of patients with moderate or severely reduced LVEF. Impaired LVEF was an independent predictor of mortality. Conclusions: Left ventricular dysfunction is a strong, independent predictor of morbidity and mortality in patients undergoing PCI despite appropriate adjunctive medical therapy. http://dx.doi.org/10.1016/j.hlc.2015.06.231