- Email: [email protected]
MELD Score: A Predictor of Mortality for Patients Receiving RVAD after LVAD Implantation
S362
The Journal of Heart and Lung Transplantation, Vol 38, No 4S, April 2019 to LVAD implantation. Our data suggests higher MELD score can predict mortality in patients supported with an RVAD after LVAD implantation. Large multi-institutional studies are needed to support these initial findings.
910 ICD Therapy in LVAD: Rates and Predictors of Appropriate and Inappropriate Shock N. Dharmavaram,1 R. Kipp,2 T. Hess,2 and R. Dhingra.3 1Department of Medicine, University of Wisconsin, Madison, WI; 2Division of Cardiovascular Medicine, University of Wisconsin, Madison, WI; and the 3 Advanced Heart Failure and Transplantation, University of Wisconsin, Madison, WI.
909 MELD Score: A Predictor of Mortality for Patients Receiving RVAD after LVAD Implantation A. Bansal,1 F. Akhtar,1 D. Jacks,1 and S. Desai.2 1Cardiothoracic Surgery, Ochsner Clinic Foundation, New Orleans, LA; and the 2Heart Transplant Med, Ochsner Clinic Foundation, New Orleans, LA. Purpose: Right ventricular failure (RVF) after LVAD implantation leads to poor prognosis. Use of Right ventricular assist device (RVAD) has become a standard practice for RVF. Even with RV support mortality up to 40% is observed. Aim of this study is to identify predictors of mortality in patients supported with an RVAD. Methods: Retrospective analysis of 16 patients who received an RVAD after an LVAD implantation were carried out. Primary end point was death. Patient’s demographic, pre-op labs, echo findings, indications and INTERMACS profile were assessed for mortality association. For normally distributed variables student’s t-test was used, and non-parametric variables had Wilcoxon-Mann-Whitney test applied. Results: 10 (62.5%) were male and 10 (62.5%) were African Americans. 6 (40%) died within 30 days of RVAD support. At time of hospital admission, variables among the “Survivor” vs. “Non-Survivor” were similar including the MELD score (30.4 § 6.52 vs. 22.44 § 9.37, p-value 0.0859). During admission patients were optimized for heart failure with inotropes and IABP. Prior to going for surgical implant majority showed an improvement of MELD score when compared to admission MELD. LVAD implantation was performed utilizing standard techniques. All RVAD implants (Protek-Duo, Tandem Life, Pittsburgh.PA) performed within first 48 hrs of LVAD implant. Poor survival was observed in patients who did not show an improvement in MELD score since admission “Non-Survivor” [Median 30(22-32)], vs. “Survivor” [Median 11(10-13)], p-value 0.0029. Mortality was 100% in patients; with MELD >30, 66.67% with MELD 20-29, 50% with MELD 15-19 and 0% in-group with MELD ≤14. Conclusion: Increased mortality is observed among patients who failed to show any significant improvement in MELD score with interventions prior
Demographics and Results Gender M: n (%) F: n (%) Race African American: n (%) Caucasian: n (%) Others: n (%) MELD-score at the time of admission Non-Survivor Survivor p-value MELD-score at the time of LVAD implant Non-Survivor Survivor p-value 30-day Survival % (n)
10 (62.5%) 6 (37.5%) 10 (62.5%) 4 (25%) 2 (12.5%) 30.4§6.52 22.44§9.37 0.0859 30 (22-32) 11 (10-18) 0.0029 62.5 % (10/16)
Purpose: Ventricular arrhythmias (VA) are common in continuous flowleft ventricular assist devices (CF-LVAD) patients. We investigated the rates of appropriate and inappropriate implantable cardioverter defibrillator (ICD) discharges following CF-LVAD placement without planned ICD reprograming. Methods: All patients with CF-LVAD and prior ICD implants from 20082018 with pre and post implant follow up data (n=82) were eligible. Appropriate ICD discharge was defined as shock received for VA as reported by an electrophysiologist, whereas shocks received for any other rhythms were considered inappropriate. Results: 16 out of 82 patients received an appropriate ICD discharge whereas 6 received an inappropriate shock during follow up (mean 1.51 years). The rates of receiving appropriate shock for VA were 19.5% (0.129 per patient year), and for inappropriate shock were 7.3% (0.064 per patient year). We compared the baseline characteristics of patients who received an appropriate ICD shock to those without any shocks (Table). In a multivariate logistic model, after adjusting for several variables including atrial fibrillation, amiodarone use, NYHA class, and type of cardiomyopathy, only the history of pre-LVAD VA was associated with higher odds of post left ventricular assist device (LVAD) appropriate discharge (p=0.004). There were no baseline characteristics predictive of inappropriate ICD shock. Conclusion: Patients with CF-LVAD and ICD have a high burden of appropriate and inappropriate ICD shocks. History of pre-LVAD VA predicted higher chances of appropriate ICD shock post LVAD. Prospective multicenter trials are necessary to investigate optimal ICD programing to safely reduce rates of appropriate and inappropriate therapy.
Table
Variable
No ICD shock (n=66)
ICD shock (n=16)
P-value
Age, years VT Zone ms ACEI/ARB, n (%) Amiodarone, n (%) Atrial Fibrillation, n (%) HF Duration > 12 months, n (%) Non-ischemic dilated cardiomyopathy, n (%) NYHA III, n (%) NYHA IV, n (%) preLVAD-VT, n (%)
52.6 335.3 29 (44%) 24 (36%) 17 (26%) 37 (56%) 34 (52%) 17 (26%) 37 (56%) 9 (14%)
56 341.2 8 (50%) 6 (38%) 7 (44%) 11 (69%) 6 (38%) 5 (31%) 8 (50%) 8 (50%)
0.34 0.76 0.66 0.93 0.16 0.36 0.31 0.66 0.66 0.001
911 Once Bitten Twice Not So Shy: Outcomes of Left Ventricular Assist Device Pump Exchange N.A. Brozzi,1 I.C. Saba,1 T. Patricelli,1 N. Thakkar Rivera,2 A. Ghodsizad,3 A. Badiye,2 S. Chaparro,2 and M. Loebe.1 1Surgery, University of Miami, Miami, FL; 2Medicine, University of Miami, Miami, FL; and the 3University of Miami & Jackson Memorial Hospital in the city of Miami, Miami, FL. Purpose: Left ventricular assist device (LVAD) failure can present as an acute complication requiring prompt diagnosis and treatment with pump
The Journal of Heart and Lung Transplantation, Vol 38, No 4S, April 2019 to LVAD implantation. Our data suggests higher MELD score can predict mortality in patients supported with an RVAD after LVAD implantation. Large multi-institutional studies are needed to support these initial findings.
910 ICD Therapy in LVAD: Rates and Predictors of Appropriate and Inappropriate Shock N. Dharmavaram,1 R. Kipp,2 T. Hess,2 and R. Dhingra.3 1Department of Medicine, University of Wisconsin, Madison, WI; 2Division of Cardiovascular Medicine, University of Wisconsin, Madison, WI; and the 3 Advanced Heart Failure and Transplantation, University of Wisconsin, Madison, WI.
909 MELD Score: A Predictor of Mortality for Patients Receiving RVAD after LVAD Implantation A. Bansal,1 F. Akhtar,1 D. Jacks,1 and S. Desai.2 1Cardiothoracic Surgery, Ochsner Clinic Foundation, New Orleans, LA; and the 2Heart Transplant Med, Ochsner Clinic Foundation, New Orleans, LA. Purpose: Right ventricular failure (RVF) after LVAD implantation leads to poor prognosis. Use of Right ventricular assist device (RVAD) has become a standard practice for RVF. Even with RV support mortality up to 40% is observed. Aim of this study is to identify predictors of mortality in patients supported with an RVAD. Methods: Retrospective analysis of 16 patients who received an RVAD after an LVAD implantation were carried out. Primary end point was death. Patient’s demographic, pre-op labs, echo findings, indications and INTERMACS profile were assessed for mortality association. For normally distributed variables student’s t-test was used, and non-parametric variables had Wilcoxon-Mann-Whitney test applied. Results: 10 (62.5%) were male and 10 (62.5%) were African Americans. 6 (40%) died within 30 days of RVAD support. At time of hospital admission, variables among the “Survivor” vs. “Non-Survivor” were similar including the MELD score (30.4 § 6.52 vs. 22.44 § 9.37, p-value 0.0859). During admission patients were optimized for heart failure with inotropes and IABP. Prior to going for surgical implant majority showed an improvement of MELD score when compared to admission MELD. LVAD implantation was performed utilizing standard techniques. All RVAD implants (Protek-Duo, Tandem Life, Pittsburgh.PA) performed within first 48 hrs of LVAD implant. Poor survival was observed in patients who did not show an improvement in MELD score since admission “Non-Survivor” [Median 30(22-32)], vs. “Survivor” [Median 11(10-13)], p-value 0.0029. Mortality was 100% in patients; with MELD >30, 66.67% with MELD 20-29, 50% with MELD 15-19 and 0% in-group with MELD ≤14. Conclusion: Increased mortality is observed among patients who failed to show any significant improvement in MELD score with interventions prior
Demographics and Results Gender M: n (%) F: n (%) Race African American: n (%) Caucasian: n (%) Others: n (%) MELD-score at the time of admission Non-Survivor Survivor p-value MELD-score at the time of LVAD implant Non-Survivor Survivor p-value 30-day Survival % (n)
10 (62.5%) 6 (37.5%) 10 (62.5%) 4 (25%) 2 (12.5%) 30.4§6.52 22.44§9.37 0.0859 30 (22-32) 11 (10-18) 0.0029 62.5 % (10/16)
Purpose: Ventricular arrhythmias (VA) are common in continuous flowleft ventricular assist devices (CF-LVAD) patients. We investigated the rates of appropriate and inappropriate implantable cardioverter defibrillator (ICD) discharges following CF-LVAD placement without planned ICD reprograming. Methods: All patients with CF-LVAD and prior ICD implants from 20082018 with pre and post implant follow up data (n=82) were eligible. Appropriate ICD discharge was defined as shock received for VA as reported by an electrophysiologist, whereas shocks received for any other rhythms were considered inappropriate. Results: 16 out of 82 patients received an appropriate ICD discharge whereas 6 received an inappropriate shock during follow up (mean 1.51 years). The rates of receiving appropriate shock for VA were 19.5% (0.129 per patient year), and for inappropriate shock were 7.3% (0.064 per patient year). We compared the baseline characteristics of patients who received an appropriate ICD shock to those without any shocks (Table). In a multivariate logistic model, after adjusting for several variables including atrial fibrillation, amiodarone use, NYHA class, and type of cardiomyopathy, only the history of pre-LVAD VA was associated with higher odds of post left ventricular assist device (LVAD) appropriate discharge (p=0.004). There were no baseline characteristics predictive of inappropriate ICD shock. Conclusion: Patients with CF-LVAD and ICD have a high burden of appropriate and inappropriate ICD shocks. History of pre-LVAD VA predicted higher chances of appropriate ICD shock post LVAD. Prospective multicenter trials are necessary to investigate optimal ICD programing to safely reduce rates of appropriate and inappropriate therapy.
Table
Variable
No ICD shock (n=66)
ICD shock (n=16)
P-value
Age, years VT Zone ms ACEI/ARB, n (%) Amiodarone, n (%) Atrial Fibrillation, n (%) HF Duration > 12 months, n (%) Non-ischemic dilated cardiomyopathy, n (%) NYHA III, n (%) NYHA IV, n (%) preLVAD-VT, n (%)
52.6 335.3 29 (44%) 24 (36%) 17 (26%) 37 (56%) 34 (52%) 17 (26%) 37 (56%) 9 (14%)
56 341.2 8 (50%) 6 (38%) 7 (44%) 11 (69%) 6 (38%) 5 (31%) 8 (50%) 8 (50%)
0.34 0.76 0.66 0.93 0.16 0.36 0.31 0.66 0.66 0.001
911 Once Bitten Twice Not So Shy: Outcomes of Left Ventricular Assist Device Pump Exchange N.A. Brozzi,1 I.C. Saba,1 T. Patricelli,1 N. Thakkar Rivera,2 A. Ghodsizad,3 A. Badiye,2 S. Chaparro,2 and M. Loebe.1 1Surgery, University of Miami, Miami, FL; 2Medicine, University of Miami, Miami, FL; and the 3University of Miami & Jackson Memorial Hospital in the city of Miami, Miami, FL. Purpose: Left ventricular assist device (LVAD) failure can present as an acute complication requiring prompt diagnosis and treatment with pump