The Association of Smoking History and Outcomes following Left Ventricular Assist Device Implantation

Abstract

IntroductionCigarette smoking has been associated with poor outcomes post-heart transplantation and is considered a contraindication for transplant candidacy at most cardiac transplant centers. Left Ventricular Assist Devices (LVAD) have proven to be durable options for patients with end stage heart failure as a bridge to transplant (BT) or destination therapy (DT); however little is known about the long-term effects of smoking on patients following LVAD implantation. The purpose of this study is to assess the impact of smoking history on the risk of complications following LVAD implantation.MethodsThis study was a single center retrospective review of 322 consecutive patients who underwent continuous-flow LVAD implantation from 5/1/2008 to 12/31/2017. Based on self-report, patients were categorized as never smokers or as having a history of smoking. Pre-LVAD implantation baseline characteristics were obtained, and summary characteristics were calculated. Hospitalizations for gastrointestinal bleeds (GIB), driveline infections, strokes, LVAD thrombosis, and heart failure re-admissions were collected. Chi square analysis was used to determine differences between never smokers and those with a history of smoking. The cumulative incidence competing risk method was used for survival analysis.ResultsMedian follow up was 228 days. Patients with a history of smoking were older, predominantly male, and more likely to be Caucasian. Smokers were more likely to be hypertensive and have dyslipidemia. There was no difference with regards to LVAD type. Over the study period (table 1), smoking history was associated with increased incidence of GIB (p = 0.008), driveline infections (p = 0.05), LVAD thrombosis (p = 0.0007), and HF hospitalizations (p = 0.039). Incidence of stroke was similar between groups (p = 0.50). There was no difference with regards to survival between the two groups (graph 1).ConclusionsA history of smoking is associated with an increased incidence of LVAD-related complications, but no difference in survival was observed. Further multivariate analysis is needed to assess persistence of effect. Cigarette smoking has been associated with poor outcomes post-heart transplantation and is considered a contraindication for transplant candidacy at most cardiac transplant centers. Left Ventricular Assist Devices (LVAD) have proven to be durable options for patients with end stage heart failure as a bridge to transplant (BT) or destination therapy (DT); however little is known about the long-term effects of smoking on patients following LVAD implantation. The purpose of this study is to assess the impact of smoking history on the risk of complications following LVAD implantation. This study was a single center retrospective review of 322 consecutive patients who underwent continuous-flow LVAD implantation from 5/1/2008 to 12/31/2017. Based on self-report, patients were categorized as never smokers or as having a history of smoking. Pre-LVAD implantation baseline characteristics were obtained, and summary characteristics were calculated. Hospitalizations for gastrointestinal bleeds (GIB), driveline infections, strokes, LVAD thrombosis, and heart failure re-admissions were collected. Chi square analysis was used to determine differences between never smokers and those with a history of smoking. The cumulative incidence competing risk method was used for survival analysis. Median follow up was 228 days. Patients with a history of smoking were older, predominantly male, and more likely to be Caucasian. Smokers were more likely to be hypertensive and have dyslipidemia. There was no difference with regards to LVAD type. Over the study period (table 1), smoking history was associated with increased incidence of GIB (p = 0.008), driveline infections (p = 0.05), LVAD thrombosis (p = 0.0007), and HF hospitalizations (p = 0.039). Incidence of stroke was similar between groups (p = 0.50). There was no difference with regards to survival between the two groups (graph 1). A history of smoking is associated with an increased incidence of LVAD-related complications, but no difference in survival was observed. Further multivariate analysis is needed to assess persistence of effect.