Opioid Use in LVAD Patients is Associated with Increased GI Bleed and Sepsis

Abstract

Purpose Post-operative pain following left ventricular assist device (LVAD) implantation is commonly managed with opioid analgesics . However, the impact of this particular therapy is unknown. The aim of this study was to compare outcomes of LVAD patients who received opioid therapy and those who did not. Methods We retrospectively reviewed all patients who underwent VAD implantation from 2014 to 2017. We divided patients into those who received opioids (OP group) and who did not (NOP group) at 3 months post LVAD implantation. At 1 year, we evaluated overall survival, as well as incidence of gastrointestinal bleeding (GIB), stroke, sepsis, driveline infection and pump thrombosis . Results Among 136 patients, 77 (57%) were in the OP group. At baseline, the OP group was younger (54 vs. 64 years, p=0.001), with a higher BMI (30.8 vs. 28, p=0.023), along with fewer males (60% vs. 81%, p=0.005), and less incidence of atrial fibrillation (23 vs. 28, p=0.018). Survival at 1 year was no different between the two groups (90% vs. 83%, p = 0.27; Figure A). The incidence of overall adverse events, stroke, driveline infection and pump thrombosis were comparable between the two groups. However, incidence of GIB (31% vs. 17%, p = 0.043) and sepsis (30% vs. 13%, p = 0.036) were significantly higher in the OP group (Figure B). Conclusion This study suggests that opioids do not negatively impact survival of the LVAD patient; however, some AEs may be negatively effected. Further research is needed linking the pathophysiology of higher adverse events with opioid use in LVAD patients.