Abstract
Background:There is an ongoing debate about the influence of the female gender on postoperative outcomes after durable left ventricular assist device (LVAD) implantation. Despite the differences in pathophysiology of heart failure in females, therapy concepts are the same as in the male population. The aim of this study was to investigate the role of the female gender in surgical heart failure therapy.Materials and methods:Between August 2010 and January 2020, 207 patients were treated with durable LVAD at out institution. We matched 111 patients in two groups to compare the outcomes in male and female patients and to stratify the risk factors of mortality.Results:The groups were matched 2:1 and were comparable after matching. We found no difference in in-hospital and follow-up mortality between male and female patients. Postoperative adverse events and complications were found to be unvaried across male and female patients. Female patients had higher rates of postoperative LVAD-thrombosis compared to their male counterparts (13.5% vs 0, p = 0.001) and the rates of renal replacement therapy lasting over 90 days were also higher in the female group (33.8% vs 56.8%, p = 0.021). Furthermore, the female gender was not an independent predictor neither of in-hospital nor follow-up mortality.Conclusions:Durable continuous flow left ventricular assist devices as a bridge to transplantation or recovery in female patients are associated with a higher risk of acute kidney injury requiring RRT and are at a higher risk of LVAD-thrombosis. Nevertheless, survival rates between genders are similar.
Highlights
The American Heart Association’s Heart Disease and Stroke Statistics—2020 Update reports that the prevalence of heart failure (HF) is on the rise, affecting over 6.5 million in Americans above the age of 20.1 HF remains the leading cause of mortality and morbidity, impacting both genders
The incidence of HF in female patients does not differ from the one in the male population, female patients remain strongly underrepresented in the HF clinical trials.[12,13]
A further aspect to consider with regards to the underrepresentation of women in such studies is the less aggressive treatment of female patients compared to their male counterparts
Summary
The American Heart Association’s Heart Disease and Stroke Statistics—2020 Update reports that the prevalence of heart failure (HF) is on the rise, affecting over 6.5 million in Americans above the age of 20.1 HF remains the leading cause of mortality and morbidity, impacting both genders . Epidemiology of HF in female patients differs to that of male patients.[6,7,8,9] a lack of large gender-specific clinical trials analyzing the durable mechanical circulatory support (MCS) therapy exists. In this study we sought to analyze our single center experience with patients treated using durable continuous flow LVAD’s in order to determine the impact of the variable “female gender” on postoperative outcomes. There is an ongoing debate about the influence of the female gender on postoperative outcomes after durable left ventricular assist device (LVAD) implantation. Female patients had higher rates of postoperative LVAD-thrombosis compared to their male counterparts (13.5% vs 0, p = 0.001) and the rates of renal replacement therapy lasting over 90 days were higher in the female group (33.8% vs 56.8%, p = 0.021).
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