Severity of End Organ Damage as a Predictor of Outcomes after Implantation of Continuous Flow Left Ventricular Assist Devices (LVAD)

Abstract

Purpose The optimal timing of implantation of LVAD in management of advanced heart failure remains controversial. We hypothesize that in patients with cardiogenic shock, the severity of end-organ dysfunction as determined by the sequential organ failure assessment (SOFA) score is a determinant of outcomes after LVAD implantation. Methods and Materials We determined the pre-operative SOFA score and short and long-term outcomes of 97 consecutive patients who received Heartmate II (HMII) or Heartware (HW) LVAD at our institution since January 2007. The performance of the score in predicting outcomes was evaluated using receiver operating characteristic (ROC) analysis. Kaplan-Meier analysis was used to compare long term survival across SOFA score sub-groups. Results ν 18±10 days, p=0.03). One year survival for SOFA scores 0-2, 3-5, 6-8 and ≥9 was 94%, 75%, 64% and 29% respectively. SOFA score was significantly lower in survivors at 6, 9,12, 24, and 36 months. SOFA score did not predict adverse outcomes of bleeding, cerebrovascular events, infection or pump exchange. [ figure 1 ] Conclusions These results show that pre-operative SOFA score is a powerful predictor of outcomes after LVAD implantation. Long-term outcomes of patients with advanced heart failure treated with LVAD can be significantly improved by early intervention prior to emergence of end-organ dysfunction.