The Effect of Extremity Vascular Complications on the Outcomes of Cardiac Support Device Recipients

Abstract

To assess the effect of extremity vascular complications (EVC; including ischemia and vessel trauma) on the outcomes of patients receiving cardiac support devices (CSD; including ventricular assist device [VAD] and extracorporeal membrane oxygenation [ECMO]). Institutional review board-approved, retrospective review of a prospectively maintained database of all temporary and permanent CSD recipients from 7/1/10 to 6/30/12. Patient demographics, procedural data, and outcomes were analyzed. The primary endpoint was all-cause mortality at 30 days post-CSD initiation. Of 208 patients who received CSDs, 31 (14.9%) experienced EVC: 13 (8.9%) of the 146 permanent VADs, 10 (26.3%) of the 38 temporary VADs, and eight (33.3%) of the 24 ECMO patients. The 30-day mortality was significantly higher for temporary VAD patients who experienced EVC versus those that did not (80.0% vs 35.7%; P = .03). However, 30-day mortality was not significantly impacted by EVC in the permanent VAD (15.4% EVC vs 4.5% without EVC; P = .15) and ECMO patients (50.0% vs 68.75%; P = 1.00). Preinitiation peripheral arterial disease and cardiogenic shock did not significantly differ between the CSD groups. Outcomes for CSD subgroups following the occurrence of EVC are shown in Table. In temporary VAD recipients, the development of extremity vascular complications results in higher 30-day mortality and more frequent withdrawal of care. In contrast, extremity vascular complications in the permanent VAD and ECMO groups did not significantly impact mortality or withdrawal of care. This prognostic data may be useful in the management of these challenging patients.TableOutcomes for 31 cardiac support device (CSD) recipients who experienced extremity vascular complications (EVC)Permanent VADTemporary VADECMOCSD recipients experiencing EVC13108OutcomesAny vascular procedure, n (%)7 (53.9%)9 (90.0%)6 (75.0%)Revascularization, n (%)5 (38.5%)4 (40.0%)2 (25.0%)Amputation, n (%)0 (0.0%)1 (10.0%)1 (12.5%)Withdrawal of care, n (%)3 (23.1%)8 (80.0%)4 (50.0%)Time to death after EVC, days (± SEM)60.14 ± 21.4815.38 ± 2.3415.20 ± 7.2130-day mortality after EVC, n (%)2 (15.4%)8 (80.0%)4 (50.0%)ECMO, Extracorporeal membrane oxygenation; SEM, standard error of the mean; VAD, ventricular assist device. Open table in a new tab