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The Association of Smoking History and Outcomes following Left Ventricular Assist Device Implantation
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Journal of Cardiac Failure Vol. 24 No. 8S August 2018
323
324
Diffuse Connective Tissue Diseases and Left-Ventricular Assist Devices: Insights from the National Inpatient Sample Ann Gage1, Vanessa Blumer2, Miguel Ortiz3, Emer Joyce1; 1Cleveland Clinic, Cleveland, OH; 2Univ. of Miami / Jackson Memorial Hospital, Miami, FL; 3University of Iowa, Iowa City, IA
The Association of Smoking History and Outcomes following Left Ventricular Assist Device Implantation Quentin R. Youmans, Allen Anderson, Kambiz Ghafourian, Duc Pham, Jonathen Rich, Esther Vorovich, Jane Wilcox, Clyde W. Yancy, Ike S. Okwuosa; Northwestern University, Chicago, IL
Background: Durable left-ventricular assist devices (LVAD) have become an increasingly frequent treatment strategy for end-stage heart failure (HF) but their use remains limited by complications including bleeding, thrombosis, and stroke. The impact of LVAD therapy on outcomes in HF patients with postulated higher risk comorbid conditions, such as diffuse connective tissue diseases (DCTD), has not been well studied to date. Given that these patients have an inherently higher risk of hematological complications than the general population, we aimed to investigate demographic characteristics and outcomes after LVAD implantation in this unique patient cohort. Methods: Using the 2010-2014 Nationwide Inpatient Sample (NIS) database, we identified the overall demographic characteristics and the incidence of common LVAD complications in patients with DCTD. When possible, univariate logistic regression and t-test were used to compare baseline characteristics, specific outcomes and in-hospital mortality after LVAD implantation in patients with and without DCTD. Results: A total of 50 patients (weighted) with DCTD were admitted for LVAD implantation from 2010-2014. Patients with DCTD were mostly female (70%), white (80%) and admitted electively for LVAD surgery (70%) (Table 1). The most common disorder was systemic lupus erythematosus (60%), followed by polymyositis (20%), systemic sclerosis (20%), and combined syndromes (10%). During the index admission, there were no in-hospital deaths or stroke in DCTD patients undergoing LVAD. The risk of transfusion (50% vs 39.8%; p 0.514; OR 1.51), hemorrhage or hematoma complicating the procedure (30% vs 20.9%; p 0.486; OR 1.61), gastrointestinal bleeding (10% vs 8.5%; p 0.86; OR 1.2), or device-related complications such as pump thrombosis (10% vs 8.6%; p 0.873; OR 1.18), was not higher when compared to patients without DCTD (Table 1). Conclusion: To our knowledge, there is no published data with advanced HF therapies in patients with DCTD. The present analysis found that patients with DCTDs undergoing LVAD therapy do not appear to have a higher risk of bleeding, thrombotic events, stroke or in-hospital mortality after device implantation, but the majority of the DCTD patients in this cohort underwent elective LVAD surgery. As LVADs become increasingly utilized in the advanced HF population, including those with systemic conditions that disqualify them for transplantation, further research is needed to identify additional adverse factors and comorbidities that could significantly impact post-LVAD outcomes.
Introduction: Cigarette smoking has been associated with poor outcomes post-heart transplantation and is considered a contraindication for transplant candidacy at most cardiac transplant centers. Left Ventricular Assist Devices (LVAD) have proven to be durable options for patients with end stage heart failure as a bridge to transplant (BT) or destination therapy (DT); however little is known about the long-term effects of smoking on patients following LVAD implantation. The purpose of this study is to assess the impact of smoking history on the risk of complications following LVAD implantation. Methods: This study was a single center retrospective review of 322 consecutive patients who underwent continuous-flow LVAD implantation from 5/1/2008 to 12/31/2017. Based on selfreport, patients were categorized as never smokers or as having a history of smoking. PreLVAD implantation baseline characteristics were obtained, and summary characteristics were calculated. Hospitalizations for gastrointestinal bleeds (GIB), driveline infections, strokes, LVAD thrombosis, and heart failure re-admissions were collected. Chi square analysis was used to determine differences between never smokers and those with a history of smoking. The cumulative incidence competing risk method was used for survival analysis. Results: Median follow up was 228 days. Patients with a history of smoking were older, predominantly male, and more likely to be Caucasian. Smokers were more likely to be hypertensive and have dyslipidemia. There was no difference with regards to LVAD type. Over the study period (table 1), smoking history was associated with increased incidence of GIB (p = 0.008), driveline infections (p = 0.05), LVAD thrombosis (p = 0.0007), and HF hospitalizations (p = 0.039). Incidence of stroke was similar between Table 1.
.
Table 1. Baseline Characteristics and Outcomes in Patients with Diffuse Connective Tissue Disease.
Graph 1. Graph 1: Survival Based on Smoking Status.
The 22nd Annual Scientific Meeting HFSA groups (p = 0.50). There was no difference with regards to survival between the two groups (graph 1). Conclusions: A history of smoking is associated with an increased incidence of LVAD-related complications, but no difference in survival was observed. Further multivariate analysis is needed to assess persistence of effect.
325 The Use of Bariatric Surgery in Patients with Left Ventricular Assist Devices to Expedite Heart Transplant Candidacy. Antonio Christophy, Sunil Bhoyrul, Ajay Srivastava, J. Thomas Heywood, Rajeev Mohan; Scripps Clinic, La Jolla, CA Introduction: Obesity is a common comorbidity which can complicate management of advance heart failure (AHF) and preclude heart transplant. The use of bariatric surgery has been studied as a weight-loss therapy in AHF patients. The left ventricular assist device (LVAD) has been used as either destination therapy or bridge to candidacy in these obese AHF patients. Methods: We reviewed bariatric surgery in LVAD patients who were implanted as bridge to candidacy as a means to expedite candidacy for cardiac transplant. A retrospective chart review was performed on LVAD patients to identify those who underwent bariatric surgery. Clinical data were collected at baseline prior to bariatric surgery and 3 months post-surgery. Data collected included age, etiology of cardiomyopathy, body mass index (BMI), bariatric procedure performed, complications, time to transplant candidacy and ultimate clinical outcome. Three patients (2 female), with a mean age of 51 (range 50-53) were reviewed. All 3 patients had a diagnosis of non-ischemic cardiomyopathy. The average baseline BMI was 39 kg/m2 (range 37- 42). Laparoscopic sleeve gastrectomy was performed on all three patients. Results: One patient had significant postoperative bleeding requiring multiple transfusions and reversal of anticoagulation. Anticoagulation was interrupted multiple times during the hospitalization due to bleeding and labile INR levels. A rise in LDH was noted during the hospitalization. One-month post discharge from bariatric surgery the patient was admitted for suspected pump thrombosis with power spikes. She was discharged home after intravenous anticoagulation with baseline LDH and power levels without any neurologic or hemodynamic sequelae. The 3-month average BMI and total weight loss percentage was 34 kg/m2 (range 30 - 38) and 12.5% (range 3.3-20.2%), respectively. All three patients were listed for transplantation with an average time to transplant candidacy of 116 days (range 105-123) following bariatric surgery. Two of the 3 patients received a heart transplant at an average of 145 days (range 130-161) from bariatric surgery. The other patient developed an intracranial hemorrhage 476 days following bariatric surgery and ultimately deemed not a transplant candidate. Conclusion: Our retrospective cohort analysis confirms the efficacy of bariatric surgery as a weight loss therapy in obese LVAD patients as a method to shorten time to transplant candidacy. Postoperative bleeding must be managed carefully in consideration of the risk of prolonged cessation of anticoagulation.
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327 Intravascular Ultrasound-Guided Percutaneous Stenting for Treatment of LVAD Outflow Graft Obstruction Vartan N. Garibyan, Farnaz Azarbal, Antonio Christophy, Christopher Vanichsarn, Curtiss T. Stinis, Rajeev Mohan; Scripps Clinic/Scripps Health, La Jolla, CA Introduction: Left ventricular assist device (LVAD) outflow graft obstruction is a well-known and significant complication. The typical management involves treatment of presumed thrombosis of the graft with intensified anticoagulation or surgery. More recently, endovascular stenting has been reported as a possible treatment option. We describe the management of a LVAD outflow cannula obstruction with never reported intravascular ultrasound (IVUS)-guided covered endovascular stenting. Case report: A 68 year-old female with non-ischemic cardiomyopathy status-post LVAD implantation in March 2016 presented with persistent symptomatic low flow alarms and clinical signs of heart failure. Symptoms seemed to worsen when she laid on her right side. She was compliant with her anticoagulation and lactate dehydrogenase level was found to be near her baseline. A CT scan with IV contrast revealed intraluminal obstruction of the LVAD outflow graft secondary to a kinked portion of the outflow cannula near the bend relief with a possible thrombotic component. The severe angulation of the cannula likely developed due to the patient’s gradual weight gain of 28kg in the 24 months since LVAD implantation. Given the patient’s risk profile, a percutaneous endovascular stenting approach was taken. IVUS was used to visualize the obstruction and kinking of the graft. A balloonexpandable covered stent was deployed at the stenotic site while the LVAD was briefly stopped to avoid stent/balloon migration. A covered stent was used to minimize the risk of thrombus migration/extrusion. IVUS was used again after post-dilation of the stent to confirm placement with no thrombus extrusion. Several hours later the patient had recurrent low-flow alarms. A repeat CT scan revealed that the kink had migrated and been transmitted within the outflow cannula towards the LVAD. The patient returned to the angiography suite where 2 balloon expandable stents were deployed more proximally within the outflow cannula and in an overlapping fashion with the original covered stent. Non-covered stents were used for the second procedure as there was no suspected thrombotic component. IVUS showed no significant residual kinking post-stenting. This was confirmed with a repeat CT scan. The patient recovered without any hemodynamic or neurologic sequelae. Conclusion: Percutaneous endovascular stenting is an emerging option for treatment of outflow tract obstruction in LVAD patients that are not candidates for surgery. IVUS can be a valuable tool during intervention to confirm proper stent position, thrombus isolation, and outflow cannula geometry.
326 ACLS and Chest Compressions in Patients with Durable LVADs Jennifer Prete, Mark Pelka, Max Liebo; Loyola University Medical Center, Maywood, IL Introduction: Durable left ventricular assist devices (LVADs) are increasingly used to improve longevity in patients with advanced heart failure; however, optimal management of end-of-life issues including cardiopulmonary arrest remains uncertain for this relatively new population. We aim to assess the safety and efficacy of Advanced Cardiovascular Life Support (ALCS) including chest compressions in patients with LVADs. Methods: We performed a retrospective chart review of all LVAD patients that received ACLS and chest compressions for in-hospital cardiopulmonary arrest at a single academic medical center between 2011 and 2017. We evaluated post-arrest survival, LVAD parameters/function, imaging studies, and autopsy results to assess for (1) structural issues such as LVAD dislodgment, aortic dissection/rupture, or pericardial effusion, and (2) LVAD mechanical issues such as hardware or software failure. Results: Durable LVADs were implanted in 191 patients during the study period, of which 18 patients (9%) suffered in-hospital cardiopulmonary arrest necessitating ACLS (median of 22.5 days, range from 1 to 1323 days from implant). Of the patients requiring ACLS 11 (61%) survived the arrest with 7 (39%) surviving to hospital discharge. Ten patients (56%) received manual external chest compressions, and 7 (39%) received defibrillator shocks. Of the patients who received chest compressions and/or defibrillator shocks, no significant changes to LVAD parameters/function was noted after the arrest. Five autopsies were completed, all of which reported the LVAD in its proper position without evidence structural or mechanical LVAD complications. Two of the surviving patients were taken emergently to the operating room for treatment of cardiac tamponade; during the procedure the LVAD anastomoses were inspected, and no bleeding was noted in either case. Two echocardiograms were performed following chest compressions without evidence of LVAD dysfunction. There were no iatrogenic sequelae identified in any of the patients following ACLS. Conclusion: While cardiopulmonary arrest in patients with LVADs is associated with high mortality, ACLS with chest compressions appears to be safe. Larger studies are warranted to identify patterns of post ALCS complications and define potential population-specific management.
328 Impact of Psychosocial Characteristics on Survival in Patients Undergoing Left Ventricular Assist Device (LVAD) Implantation Alexander Rodriguez, Ramsey Wehbe, Allen Anderson, Kambiz Ghafourian, Ike Okwuosa, Jane Wilcox, Esther Vorovich, Adam Hubert, Duc Pham, Jonathan D. Rich; Northwestern University, Chicago, IL Purpose of Study: The evaluation of patients for LVAD candidacy routinely includes an assessment of patient characteristics referred to as “psychosocial” variables. While psychosocial risk may impact long term survival in heart transplantation, its impact on LVAD outcomes is less clear. We thus sought to determine whether psychosocial characteristics are predictive of worse survival following LVAD implantation. Methods: We included all patients implanted with an LVAD at our institution from 2008-2018, each of whom underwent a highly detailed psychosocial assessment by our clinical psychology team as part of each patient’s comprehensive pre-implant evaluation. Survival analyses were performed using the Fine-Gray model for competing-risks to determine cumulative incidence functions. For statistically significant variables, cause-specific subdistribution hazard ratio estimates were obtained. Results: A total of 365 patients received an LVAD, 207 as bridge to transplant (BTT) and 158 as destination therapy (DT). The psychosocial characteristics of the entire LVAD cohort, including stratification by LVAD indication of BTT or DT, are shown in the table. Many patients receiving LVADs had features often perceived to be of higher psychosocial risk including absence of a reliable caregiver (26%), gaps in health literacy (30%), and poor medication (18%), diet (37%), and
Journal of Cardiac Failure Vol. 24 No. 8S August 2018
323
324
Diffuse Connective Tissue Diseases and Left-Ventricular Assist Devices: Insights from the National Inpatient Sample Ann Gage1, Vanessa Blumer2, Miguel Ortiz3, Emer Joyce1; 1Cleveland Clinic, Cleveland, OH; 2Univ. of Miami / Jackson Memorial Hospital, Miami, FL; 3University of Iowa, Iowa City, IA
The Association of Smoking History and Outcomes following Left Ventricular Assist Device Implantation Quentin R. Youmans, Allen Anderson, Kambiz Ghafourian, Duc Pham, Jonathen Rich, Esther Vorovich, Jane Wilcox, Clyde W. Yancy, Ike S. Okwuosa; Northwestern University, Chicago, IL
Background: Durable left-ventricular assist devices (LVAD) have become an increasingly frequent treatment strategy for end-stage heart failure (HF) but their use remains limited by complications including bleeding, thrombosis, and stroke. The impact of LVAD therapy on outcomes in HF patients with postulated higher risk comorbid conditions, such as diffuse connective tissue diseases (DCTD), has not been well studied to date. Given that these patients have an inherently higher risk of hematological complications than the general population, we aimed to investigate demographic characteristics and outcomes after LVAD implantation in this unique patient cohort. Methods: Using the 2010-2014 Nationwide Inpatient Sample (NIS) database, we identified the overall demographic characteristics and the incidence of common LVAD complications in patients with DCTD. When possible, univariate logistic regression and t-test were used to compare baseline characteristics, specific outcomes and in-hospital mortality after LVAD implantation in patients with and without DCTD. Results: A total of 50 patients (weighted) with DCTD were admitted for LVAD implantation from 2010-2014. Patients with DCTD were mostly female (70%), white (80%) and admitted electively for LVAD surgery (70%) (Table 1). The most common disorder was systemic lupus erythematosus (60%), followed by polymyositis (20%), systemic sclerosis (20%), and combined syndromes (10%). During the index admission, there were no in-hospital deaths or stroke in DCTD patients undergoing LVAD. The risk of transfusion (50% vs 39.8%; p 0.514; OR 1.51), hemorrhage or hematoma complicating the procedure (30% vs 20.9%; p 0.486; OR 1.61), gastrointestinal bleeding (10% vs 8.5%; p 0.86; OR 1.2), or device-related complications such as pump thrombosis (10% vs 8.6%; p 0.873; OR 1.18), was not higher when compared to patients without DCTD (Table 1). Conclusion: To our knowledge, there is no published data with advanced HF therapies in patients with DCTD. The present analysis found that patients with DCTDs undergoing LVAD therapy do not appear to have a higher risk of bleeding, thrombotic events, stroke or in-hospital mortality after device implantation, but the majority of the DCTD patients in this cohort underwent elective LVAD surgery. As LVADs become increasingly utilized in the advanced HF population, including those with systemic conditions that disqualify them for transplantation, further research is needed to identify additional adverse factors and comorbidities that could significantly impact post-LVAD outcomes.
Introduction: Cigarette smoking has been associated with poor outcomes post-heart transplantation and is considered a contraindication for transplant candidacy at most cardiac transplant centers. Left Ventricular Assist Devices (LVAD) have proven to be durable options for patients with end stage heart failure as a bridge to transplant (BT) or destination therapy (DT); however little is known about the long-term effects of smoking on patients following LVAD implantation. The purpose of this study is to assess the impact of smoking history on the risk of complications following LVAD implantation. Methods: This study was a single center retrospective review of 322 consecutive patients who underwent continuous-flow LVAD implantation from 5/1/2008 to 12/31/2017. Based on selfreport, patients were categorized as never smokers or as having a history of smoking. PreLVAD implantation baseline characteristics were obtained, and summary characteristics were calculated. Hospitalizations for gastrointestinal bleeds (GIB), driveline infections, strokes, LVAD thrombosis, and heart failure re-admissions were collected. Chi square analysis was used to determine differences between never smokers and those with a history of smoking. The cumulative incidence competing risk method was used for survival analysis. Results: Median follow up was 228 days. Patients with a history of smoking were older, predominantly male, and more likely to be Caucasian. Smokers were more likely to be hypertensive and have dyslipidemia. There was no difference with regards to LVAD type. Over the study period (table 1), smoking history was associated with increased incidence of GIB (p = 0.008), driveline infections (p = 0.05), LVAD thrombosis (p = 0.0007), and HF hospitalizations (p = 0.039). Incidence of stroke was similar between Table 1.
.
Table 1. Baseline Characteristics and Outcomes in Patients with Diffuse Connective Tissue Disease.
Graph 1. Graph 1: Survival Based on Smoking Status.
The 22nd Annual Scientific Meeting HFSA groups (p = 0.50). There was no difference with regards to survival between the two groups (graph 1). Conclusions: A history of smoking is associated with an increased incidence of LVAD-related complications, but no difference in survival was observed. Further multivariate analysis is needed to assess persistence of effect.
325 The Use of Bariatric Surgery in Patients with Left Ventricular Assist Devices to Expedite Heart Transplant Candidacy. Antonio Christophy, Sunil Bhoyrul, Ajay Srivastava, J. Thomas Heywood, Rajeev Mohan; Scripps Clinic, La Jolla, CA Introduction: Obesity is a common comorbidity which can complicate management of advance heart failure (AHF) and preclude heart transplant. The use of bariatric surgery has been studied as a weight-loss therapy in AHF patients. The left ventricular assist device (LVAD) has been used as either destination therapy or bridge to candidacy in these obese AHF patients. Methods: We reviewed bariatric surgery in LVAD patients who were implanted as bridge to candidacy as a means to expedite candidacy for cardiac transplant. A retrospective chart review was performed on LVAD patients to identify those who underwent bariatric surgery. Clinical data were collected at baseline prior to bariatric surgery and 3 months post-surgery. Data collected included age, etiology of cardiomyopathy, body mass index (BMI), bariatric procedure performed, complications, time to transplant candidacy and ultimate clinical outcome. Three patients (2 female), with a mean age of 51 (range 50-53) were reviewed. All 3 patients had a diagnosis of non-ischemic cardiomyopathy. The average baseline BMI was 39 kg/m2 (range 37- 42). Laparoscopic sleeve gastrectomy was performed on all three patients. Results: One patient had significant postoperative bleeding requiring multiple transfusions and reversal of anticoagulation. Anticoagulation was interrupted multiple times during the hospitalization due to bleeding and labile INR levels. A rise in LDH was noted during the hospitalization. One-month post discharge from bariatric surgery the patient was admitted for suspected pump thrombosis with power spikes. She was discharged home after intravenous anticoagulation with baseline LDH and power levels without any neurologic or hemodynamic sequelae. The 3-month average BMI and total weight loss percentage was 34 kg/m2 (range 30 - 38) and 12.5% (range 3.3-20.2%), respectively. All three patients were listed for transplantation with an average time to transplant candidacy of 116 days (range 105-123) following bariatric surgery. Two of the 3 patients received a heart transplant at an average of 145 days (range 130-161) from bariatric surgery. The other patient developed an intracranial hemorrhage 476 days following bariatric surgery and ultimately deemed not a transplant candidate. Conclusion: Our retrospective cohort analysis confirms the efficacy of bariatric surgery as a weight loss therapy in obese LVAD patients as a method to shorten time to transplant candidacy. Postoperative bleeding must be managed carefully in consideration of the risk of prolonged cessation of anticoagulation.
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327 Intravascular Ultrasound-Guided Percutaneous Stenting for Treatment of LVAD Outflow Graft Obstruction Vartan N. Garibyan, Farnaz Azarbal, Antonio Christophy, Christopher Vanichsarn, Curtiss T. Stinis, Rajeev Mohan; Scripps Clinic/Scripps Health, La Jolla, CA Introduction: Left ventricular assist device (LVAD) outflow graft obstruction is a well-known and significant complication. The typical management involves treatment of presumed thrombosis of the graft with intensified anticoagulation or surgery. More recently, endovascular stenting has been reported as a possible treatment option. We describe the management of a LVAD outflow cannula obstruction with never reported intravascular ultrasound (IVUS)-guided covered endovascular stenting. Case report: A 68 year-old female with non-ischemic cardiomyopathy status-post LVAD implantation in March 2016 presented with persistent symptomatic low flow alarms and clinical signs of heart failure. Symptoms seemed to worsen when she laid on her right side. She was compliant with her anticoagulation and lactate dehydrogenase level was found to be near her baseline. A CT scan with IV contrast revealed intraluminal obstruction of the LVAD outflow graft secondary to a kinked portion of the outflow cannula near the bend relief with a possible thrombotic component. The severe angulation of the cannula likely developed due to the patient’s gradual weight gain of 28kg in the 24 months since LVAD implantation. Given the patient’s risk profile, a percutaneous endovascular stenting approach was taken. IVUS was used to visualize the obstruction and kinking of the graft. A balloonexpandable covered stent was deployed at the stenotic site while the LVAD was briefly stopped to avoid stent/balloon migration. A covered stent was used to minimize the risk of thrombus migration/extrusion. IVUS was used again after post-dilation of the stent to confirm placement with no thrombus extrusion. Several hours later the patient had recurrent low-flow alarms. A repeat CT scan revealed that the kink had migrated and been transmitted within the outflow cannula towards the LVAD. The patient returned to the angiography suite where 2 balloon expandable stents were deployed more proximally within the outflow cannula and in an overlapping fashion with the original covered stent. Non-covered stents were used for the second procedure as there was no suspected thrombotic component. IVUS showed no significant residual kinking post-stenting. This was confirmed with a repeat CT scan. The patient recovered without any hemodynamic or neurologic sequelae. Conclusion: Percutaneous endovascular stenting is an emerging option for treatment of outflow tract obstruction in LVAD patients that are not candidates for surgery. IVUS can be a valuable tool during intervention to confirm proper stent position, thrombus isolation, and outflow cannula geometry.
326 ACLS and Chest Compressions in Patients with Durable LVADs Jennifer Prete, Mark Pelka, Max Liebo; Loyola University Medical Center, Maywood, IL Introduction: Durable left ventricular assist devices (LVADs) are increasingly used to improve longevity in patients with advanced heart failure; however, optimal management of end-of-life issues including cardiopulmonary arrest remains uncertain for this relatively new population. We aim to assess the safety and efficacy of Advanced Cardiovascular Life Support (ALCS) including chest compressions in patients with LVADs. Methods: We performed a retrospective chart review of all LVAD patients that received ACLS and chest compressions for in-hospital cardiopulmonary arrest at a single academic medical center between 2011 and 2017. We evaluated post-arrest survival, LVAD parameters/function, imaging studies, and autopsy results to assess for (1) structural issues such as LVAD dislodgment, aortic dissection/rupture, or pericardial effusion, and (2) LVAD mechanical issues such as hardware or software failure. Results: Durable LVADs were implanted in 191 patients during the study period, of which 18 patients (9%) suffered in-hospital cardiopulmonary arrest necessitating ACLS (median of 22.5 days, range from 1 to 1323 days from implant). Of the patients requiring ACLS 11 (61%) survived the arrest with 7 (39%) surviving to hospital discharge. Ten patients (56%) received manual external chest compressions, and 7 (39%) received defibrillator shocks. Of the patients who received chest compressions and/or defibrillator shocks, no significant changes to LVAD parameters/function was noted after the arrest. Five autopsies were completed, all of which reported the LVAD in its proper position without evidence structural or mechanical LVAD complications. Two of the surviving patients were taken emergently to the operating room for treatment of cardiac tamponade; during the procedure the LVAD anastomoses were inspected, and no bleeding was noted in either case. Two echocardiograms were performed following chest compressions without evidence of LVAD dysfunction. There were no iatrogenic sequelae identified in any of the patients following ACLS. Conclusion: While cardiopulmonary arrest in patients with LVADs is associated with high mortality, ACLS with chest compressions appears to be safe. Larger studies are warranted to identify patterns of post ALCS complications and define potential population-specific management.
328 Impact of Psychosocial Characteristics on Survival in Patients Undergoing Left Ventricular Assist Device (LVAD) Implantation Alexander Rodriguez, Ramsey Wehbe, Allen Anderson, Kambiz Ghafourian, Ike Okwuosa, Jane Wilcox, Esther Vorovich, Adam Hubert, Duc Pham, Jonathan D. Rich; Northwestern University, Chicago, IL Purpose of Study: The evaluation of patients for LVAD candidacy routinely includes an assessment of patient characteristics referred to as “psychosocial” variables. While psychosocial risk may impact long term survival in heart transplantation, its impact on LVAD outcomes is less clear. We thus sought to determine whether psychosocial characteristics are predictive of worse survival following LVAD implantation. Methods: We included all patients implanted with an LVAD at our institution from 2008-2018, each of whom underwent a highly detailed psychosocial assessment by our clinical psychology team as part of each patient’s comprehensive pre-implant evaluation. Survival analyses were performed using the Fine-Gray model for competing-risks to determine cumulative incidence functions. For statistically significant variables, cause-specific subdistribution hazard ratio estimates were obtained. Results: A total of 365 patients received an LVAD, 207 as bridge to transplant (BTT) and 158 as destination therapy (DT). The psychosocial characteristics of the entire LVAD cohort, including stratification by LVAD indication of BTT or DT, are shown in the table. Many patients receiving LVADs had features often perceived to be of higher psychosocial risk including absence of a reliable caregiver (26%), gaps in health literacy (30%), and poor medication (18%), diet (37%), and