(564) - Effect of Pre-operative Albumin Level on Patient Outcomes after Implantation of Continuous Flow Left Ventricular Assist Device

Abstract

Low pre-operative serum albumin levels have been shown to portend worse outcomes in surgical patients. Recent clinical data suggest that heart failure patients with low serum albumin levels undergoing heart transplantation or implantation of a left ventricular assist device (LVAD) have decreased survival. Ninety one patients implanted with a continuous flow LVAD since 2011 were stratified into two groups based on pre-operative albumin <3.0 mg/dL (low; n=29) or ≥3 (normal; n=62). Peri-operative clinical parameters were derived from the STS database. Follow-up survival was assessed using the Social Security Death Index. Pre-operative data are shown in the Table. Operative mortality was higher in the low group (21% vs 3%; p=0.01) as was renal failure (41% vs 23%; p=0.02), length of ICU stay (430±546 vs 232±285 hrs; p=0.03), and need for skilled nursing discharge (43% vs 13%; p=0.005). Three, six and 12 month survival was 93%, 90%, and 87% and 75%, 72% and 72% in the normal and low albumin groups, respectively (p=0.02, Figure 1). In patients undergoing implantation of a continuous flow LVAD, pre-operative serum albumin level of less than 3.0 mg/dL is associated with higher perioperative mortality and renal failure, decreased 12 month survival, and increased need for discharge to a skilled nursing facility. Pre-operative optimization of physiologic factors which influence albumin levels may improve clinical outcomes and survival in continuous flow LVAD patients.Table 1Albumin<3Albumin≥3p-valueAlbumin2.7±0.13.3±0.20.007INTERMACS2.7±1.32.6±1.4NSBMI29±229±5NSCreatinine1.3±0.51.3±0.4NSAge62±1158±14NSMale76%(22/29)82%(51/62)NSCOPD55%(16/29)52%(32/62)NSDiabetes41%(12/29)40%(25/62)NSHTN86%(25/29)79%(49/62)NSCerebrovascular28%(8/29)13%(8/63)NS Open table in a new tab