Does Elective or Emergent Operative Status Influence Outcomes in Patients Undergoing Implantation of Left Ventricular Assist Devices?

Athanasios Tsiouris, Jeffrey A. Morgan, Hassan W. Nemeh, Arielle Hodari, Rupen Shah, Robert J. Brewer, Gaetano Paone


Background: Acuity models to predict survival after left ventricular assist device (LVAD) implantation do not include operative status as one of the calculated variables. The effect of elective versus emergent LVAD implantation on outcomes has not been examined.

Methods: Patients were stratified into 2 groups based on operative status (elective versus emergent). Variables were compared to determine whether there were differences in outcomes between elective versus emergent LVAD recipients

Results: Of the 130 patients, 59 underwent an elective procedure, whereas 71 had their LVAD implanted as an urgent/emergent operation. Patients in the urgent/emergent cohort had significantly worse preoperative hepatic and renal function and higher central venous pressures. Survival rates at 30 days, 6 months, 1 year, and 2 years were analogous for both cohorts. Patients in the emergent cohort had a higher incidence of postoperative right ventricular failure, with the requirement for short-term right ventricular support in 9.9% versus 1.7% (P = 0.054). The incidence of other LVAD-related complications, were similar in both groups. Emergency status did not predict postoperative mortality in univariate analysis.

Conclusions: Although patients who underwent emergent LVAD implantations had worse preoperative renal and liver function and a higher incidence of postoperative right ventricular failure, they exhibited similar midterm survival and a similar incidence of other postoperative complications.

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