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

Authors

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

DOI:

https://doi.org/10.1532/HSF98.2013298

Abstract

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.

References

Barbone A, Rao V, Oz MC, Naka Y. 2002. LVAD Support in patients with bioprosthetic valves. Ann Thorac Surg 74:232-4.nBoyle AJ, Ascheim DD, Russo MJ, et al. 2011. Clinical outcomes for continuous-flow left ventricular assist device patients stratified by pre-operative INTERMACS classification. J Heart Lung Transplant 30:402-7.nCraver JM, Weintraub WS, Jones EL, Guyton RA, Hatcher CR Jr. 1992. Emergency coronary artery bypass surgery for failed percutaneous coronary angioplasty. A 10-year experience. Ann Surg 215:425-33; discussion 433-4.nChristakis GT, Weisel RD, David TE, Salerno TA, Ivanov J. 1988. Predictors of operative survival after valve replacement. Circulation 78(3 Pt 2):I25-34.nCowger J, Sundareswaran K, Rogers JG, et al. 2013. Predicting survival in patients receiving continuous flow left ventricular assist devices: the HeartMate II risk score. J Am Coll Cardiol 61:313-21.nCzer LS, Gray RJ, DeRobertis MA, et al. 1984. Mitral valve replacement: impact of coronary artery disease and determinants of prognosis after revascularization. Circulation 70(3 Pt 2):I198-207.nGeissler HJ, Hölzl P, Marohl S, et al. 2000. Risk stratification in heart surgery: comparison of six score systems. Eur J Cardiothorac Surg 17:400-6.nGranton J, Cheng D. 2008. Risk stratification models for cardiac surgery. Semin Cardiothorac Vasc Anesth 12:167-74.nJohn R, Kamdar F, Liao K, Colvin-Adams M, Boyle A, Joyce L. 2008. Improved survival and decreasing incidence of adverse events using the HeartMate II left ventricular assist device as a bridge-to-transplant. Ann Thorac Surg 86:1227-35.nKirklin JK, Naftel DC, Kormos RL, et al. 2013. Fifth INTERMACS annual report: risk factor analysis from more than 6,000 mechanical circulatory support patients. J Heart Lung Transplant 32:141-56.nKolh P. 2006. Importance of risk stratification models in cardiac surgery. Eur Heart J 27:768-9.nLaPar DJ, Hennessy S, Fonner E, Kern JA, Kron IL, Ailawadi G. 2010. Does urgent or emergent status influence choice in mitral valve operations? An analysis of outcomes from the Virginia Cardiac Surgery Quality Initiative. Ann Thorac Surg 90:153-60.nLietz K, Long JW, Kfoury AG, et al. 2007. Outcomes of left ventricular assist device implantation as destination therapy in the post-REMATCH era: implications for patient selection. Circulation 116:497-505.nMiller LW, Pagani FD, Russell SD, et al. 2007. Use of a continuous-flow device in patients awaiting heart transplantation. N Engl J Med 357:885-96.nNilsson J, Algotsson L, Höglund P, Lührs C, Brandt J. 2006. Comparison of 19 pre-operative risk stratification models in open-heart surgery. Eur Heart J 27:867-74.nOz MC, Goldstein DJ, Pepino P, et al. 1995. Screening scale predicts patients successfully receiving long-term implantable left ventricular assist devices. Circulation 92(9 Suppl):II169-73.nPagani FD, Miller LW, Russell SD, et al. 2009. Extended mechanical circulatory support with a continuous-flow rotary left ventricular assist device. J Am Coll Cardiol 54:312-21.nSlaughter MS, Rogers JG, Milano CA, et al. 2009. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med 361:2241-51.nSlaughter MS, Pagani FD, Rogers JG, et al. 2010. Clinical management of continuous-flow left ventricular assist devices in advanced heart failure. J Heart Lung Transplant 29:S1-39.nRose EA, Gelijns AC, Moskowitz AJ, et al. 2001. Long-term use of left ventricular assist devices for end-stage heart failure. N Engl J Med 345:1435-43.nSong HK, Kindem M, Bavaria JE, et al. 2012. Long-term implications of emergency versus elective proximal aortic surgery in patients with Marfan syndrome in the Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions Consortium Registry. J Thorac Cardiovasc Surg 143:282-6.nStark KS, Satler LF, Krucoff MW, Rackley CE, Kent KM. 1990. Myocardial salvage after failed coronary angioplasty. J Am Coll Cardiol 15:78-82.nStepanenko A, Potapov EV, Jurmann B, et al. 2010. Outcomes of elective versus emergent permanent mechanical circulatory support in the elderly: a single-center experience. J Heart Lung Transplant 29:61-5.nStevenson LW, Pagani FD, Young JB, et al. 2009. INTERMACS profiles of advanced heart failure: the current picture. J Heart Lung Transplant 28:535-41.nTeuteberg JJ, Ewald GA, Adamson RM, et al. 2012. Risk assessment for continuous flow left ventricular assist devices: does the destination therapy risk score work? An analysis of over 1,000 patients. J Am Coll Cardiol 60:44-51.nThourani VH, Weintraub WS, Craver JM, et al. 2000. Influence of concomitant CABG and urgent/emergent status on mitral valve replacement surgery. Ann Thorac Surg 70:778-83; discussion 783-4.nWendt D, Osswald BR, Kayser K, et al. 2009. Society of Thoracic Surgeons score is superior to the EuroSCORE determining mortality in high-risk patients undergoing isolated aortic valve replacement. Ann Thorac Surg. 88:468-74; discussion 474-5.nYang C, Li D, Mennett R, et al. 2012 Urgent aortic valve replacement in octogenarians: does an ‘urgent’ status increase morbidity and mortality? J Heart Valve Dis 21:487-93.n

Published

2014-05-07

How to Cite

Tsiouris, A., Morgan, J. A., Nemeh, H. W., Hodari, A., Shah, R., Brewer, R. J., & Paone, G. (2014). Does Elective or Emergent Operative Status Influence Outcomes in Patients Undergoing Implantation of Left Ventricular Assist Devices?. The Heart Surgery Forum, 17(2), E64-E72. https://doi.org/10.1532/HSF98.2013298

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