Post-operative Bleeding Increases the Rate of Right Ventricular Failure and In-Hospital Mortality after LVAD Implantation

Abstract

Purpose Surgical bleeding in the immediate post-operative period presents a frequent challenge in the management of LVAD recipients. We hypothesized that implementing an aggressive approach to surgical hemostasis would reduce the rate of early mortality. Methods We conducted a single-center retrospective review of 78 patients who underwent LVAD implantation between 9/13/11 and 8/24/17. Logistic regressions were utilized to estimate the odds ratio for RVAD requirement and in-hospital mortality based on risk factors of six-hour chest tube output and return to operating room for bleeding. Chest tube output of greater than 600 cc in the first six hours was considered to be significant. Results When comparing chest tube outputs in the first six hours, there were no significant differences in age, gender, heart failure etiology, or device type in patients with >600 cc and those with lower outputs. Greater than 600 cc chest tube output in the first six hours was an independent predictor for RVAD requirement (15.2% vs. 2.3%, p=0.04) and in-hospital mortality (24.2% vs. 4.7%, p=0.012) than those with lower outputs. Patients who returned to the operating room for bleeding complications experienced a similar in-hospital mortality rate (17.6% vs. 9.3%, p=0.28) but had a higher RVAD requirement (14.7% vs. 2.3%, p=0.04). Multivariate analysis showed a statistical significance for in-patient mortality in patients with chest tube output >600 cc in the first 6 hours (p = 0.013). There was a close correlation between the amount of chest tube output during the first six hours and the risk of in-hospital mortality ( Figure 2 ). Conclusion Minimizing the degree of post-operative bleeding after LVAD surgery may result in a reduced rate of right ventricular failure and in-hospital mortality. These findings suggest that efforts should be undertaken to identify surgical strategies for achieving improved hemostasis at the time of implantation.