Risk factor analysis of Swedish Left Ventricular Assist Device (LVAD) patients

Abstract

Background The use of left ventricular assist devices (LVADs) is established as a bridge to heart transplantation. Methods All Swedish patients on the waiting list for heart transplantation, treated with LVAD since 1993 were retrospectively collected into a database and analyzed in regards to risk factors for mortality and morbidity. Results Fifty-nine patients (46 men) with a median age of 49 years (range, 14 to 69 years), Higgins score median of 9 (range, 3 to 15), EuroScore median of 10 (range, 5 to 17) were investigated. Dominating diagnoses were dilated cardiomyopathy in 61% (n = 36) and ischemic cardiomyopathy in 18.6% (n = 11). The patients were supported with LVAD for a median time of 99.5 days (range, 1 to 873 days). Forty-five (76%) patients received transplants, and 3 (5.1%) patients were weaned from the device. Eleven patients (18.6%) died during LVAD treatment. Risk factor analysis for mortality before heart transplantation showed significance for a high total amount of autologous blood transfusions ( p < 0.001), days on mechanical ventilation postoperatively ( p < 0.001), prolonged postoperative intensive care unit stay ( p = 0.007), and high central venous pressure 24 hours postoperatively and at the final measurement ( p = 0.03 and 0.01, respectively). Mortality with LVAD treatment was 18.6% (n = 11). High C-reactive protein ( p = 0.001), low mean arterial pressure ( p = 0.03), and high cardiac index ( p = 0.03) preoperatively were risk factors for development of right ventricular failure during LVAD treatment. Conclusions The Swedish experience with LVAD as a bridge to heart transplantation was retrospectively collected into a database. This included data from transplant and nontransplant centers. Figures of mortality and morbidity in the database were comparable to international experience. Specific risk factors were difficult to define retrospectively as a result of different protocols for follow-up among participating centers.