72 Degree of End Organ Damage as a Predictor of Outcomes after Mechanical Circulatory Support Device Implantation – A More Quantitative Assessment

Abstract

Purpose Heart failure (HF) is a complex syndrome involving multiple organ systems. With the advancement of the disease there is progressive decline in organ system functions. Degree of end organ damage (EOD) caused by HF is believed to be associated with poor outcomes after mechanical circulatory support device (MCSD) implantation but more quantitative tools for the assessment of EOD are lacking. In this study we hypothesized that degree of EOD as assessed by Sequential organ failure assessment (SOFA) score is an important predictor of outcomes after MCSD implantation. Methods and Materials We analyzed the data from 211 patients who underwent MCSD implantation at CUMC between 2000 and 2010. SOFA score was calculated within a week before the MCSD surgery and its performance was evaluated using receiver operating characteristic (ROC) analysis. Overall mortality rates were compared across different SOFA score groups using Chi-square test. Post-operative survival was also compared across SOFA score groups using Kaplan-Meier survival analysis. Download : Download high-res image (38KB) Download : Download full-size image Results There was a gradual increase in mortality rate with the increase in SOFA score. There was 12.5% mortality rate with SOFA score ≤4, 76.4% with SOFA score 5-8, 95% with SOFA score 9-12, and 95% with SOFA score >13 (p=0.000). The survival at 3-month, 6-month, 9-month and 12-month was significantly poor in higher SOFA score groups (p=0.000). Conclusions These results show that degree of EOD as measured by the SOFA score is a strong predictor of outcomes and survival after MCSD implantation in HF patients. This approach may provide a very valuable tool for the selection of patients and/or selection of appropriate time for surgery in HF patients.