Tightly Controlled Diabetes By Hemoglobin A1c Does Not Appear to Neutralize the Adverse Effects of Diabetes On Outcomes After Left Ventricular Assist Device Placement.

Abstract

Purpose: It is known that well controlled diabetes (DM) patients (Pts) are associated with less diabetic complications. It is not known whether DM pts requiring left ventricular assist devices (LVADs) are at a greater risk of complications/death even if their blood glucose is well controlled. Therefore, we evaluated our DM LVAD pts with normal hemogloblin A1c (HbA1c) to assess for survival and complications. Methods: Between 2010 and 2013 we evaluated 13 LVAD pts with good DM control defined as HBA1c < 7%. Pts were compared to 33 pts who had LVAD implant at the same time but did not have DM. Endpoints included: 6-month survival, 6-month freedom from treated infection including driveline infection and infection of the device. Incidences of non-infectious complications were also assessed, including: stroke/TIA, worsening heart failure, peri-operative bleeding, acute kidney injury, gastrointestinal bleeding, clot/thromboembolism, ventricular arrhythmia, and respiratory failure. Results: The average HBA1c level among DM LVAD pts was 5.9± 0.7%. DM pts had significantly lower 6-month survival compared to pts without DM (54% in DM pts and 82% in pts without DM, p = 0.04). The causes of death included: worsening heart failure (n=2), multi-organ dysfunction (n=3), and significant bleeding (n=1). 6-month freedom from treated infection is numerically lower in DM LVAD group (46% in DM pts and 55% in pts without DM, p = 0.74). There is no difference in incidences of non-infectious complications between the two groups (see table).Table 1: Comparison of incidences of non-infectious complications between LVAD patients with DM and without DMConclusion: Even properly managed DM pts necessitating LVAD have higher risk for mortality. A larger sample size is needed to confirm whether the causes of death is due to the underlying DM. DISCLOSURES:Moriguchi, J.: Grant/Research Support, Thoratec, Syncardia. Arabia, F.: Other, Syncardia, Consultant. Patel, J.: Grant/Research Support, Alexion Pharmaceuticals. Chang, D.: Stockholder, Abbot Pharmaceuticals, ABBV. Esmailian, F.: Grant/Research Support, Transmedics. Kobashigawa, J.: Grant/Research Support, XDx Inc., Novartis.