Days alive and out of hospital after left ventricular assist device implantation
Abstract Aims Implantation of left ventricular assist devices (LVADs) as a bridge to transplant or as destination therapy is increasing. The selection of suitable patients and outcome assessment belong to the key challenges. Mortality has traditionally been a focus of research in this field, but lit...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-08-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.13942 |
| _version_ | 1818510521708576768 |
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| author | Sebastian Roth René M'Pembele Alexandra Stroda Josephine Voit Giovanna Lurati Buse Stephan U. Sixt Ralf Westenfeld Amin Polzin Philipp Rellecke Igor Tudorache Markus W. Hollmann Udo Boeken Payam Akhyari Artur Lichtenberg Ragnar Huhn Hug Aubin |
| author_facet | Sebastian Roth René M'Pembele Alexandra Stroda Josephine Voit Giovanna Lurati Buse Stephan U. Sixt Ralf Westenfeld Amin Polzin Philipp Rellecke Igor Tudorache Markus W. Hollmann Udo Boeken Payam Akhyari Artur Lichtenberg Ragnar Huhn Hug Aubin |
| author_sort | Sebastian Roth |
| collection | DOAJ |
| description | Abstract Aims Implantation of left ventricular assist devices (LVADs) as a bridge to transplant or as destination therapy is increasing. The selection of suitable patients and outcome assessment belong to the key challenges. Mortality has traditionally been a focus of research in this field, but literature on quality of life is very limited. This study aimed to identify perioperative factors influencing patients' life as measured by days alive and out of hospital (DAOH) in the first year after LVAD implantation. Methods and results This retrospective single‐centre cohort study screened 227 patients who underwent LVAD implantation at the University Hospital Duesseldorf, Germany, between 2010 and 2020. First, the influence of 10 prespecified variables on DAOH was investigated by univariate analysis. Second, multivariate quantile regression was conducted including all factors with significant influence on DAOH in the univariate model. Additionally, the impact of all variables on 1 year mortality was investigated using Kaplan–Meier curves to oppose DAOH and mortality. In total, 221 patients were included into analysis. As pre‐operative factors, chronic kidney disease (CKD), pre‐operative mechanical circulatory support (pMCS), and Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) stadium < 3 were associated with lower DAOH at 1 year [CKD: 280 (155–322) vs. 230 (0–219), P = 0.0286; pMCS: 294 (155–325) vs. 243 (0–293), P = 0.0004; INTERMACS 1: 218 (0–293) vs. INTERMACS 2: 264 (6–320) vs. INTERMACS 3: 299 (228–325) vs. INTERMACS 4: 313 (247–332), P ≤ 0.0001]. Intra‐operative additional implantation of a right ventricular assist device (RVAD) was also associated with lower DAOH [RVAD: 290 (160–325) vs. 174 (0–277), P ≤ 0.0001]. As post‐operative values that were associated with lower DAOH, dialysis and tracheotomy could be identified [dialysis: 300 (252–326) vs. 186 (0–300), P ≤ 0.0001; tracheotomy: 292 (139–325) vs. 168 (0–269), P ≤ 0.0001]. Multivariate analysis revealed that all of these factors besides pMCS were independently associated with DAOH. According to Kaplan–Meier analysis, only post‐operative dialysis was significantly associated with increased mortality at 1 year (survival: no dialysis 89.4% vs. dialysis 70.1%, hazard ratio: 0.56, 95% confidence interval: 0.33–0.94; P = 0.031). Conclusions The results of this study indicate that there can be a clear discrepancy between hard endpoints such as mortality and more patient‐centred outcomes reflecting life impact. DAOH may relevantly contribute to a more comprehensive selection process and outcome assessment in LVAD patients. |
| first_indexed | 2024-12-10T23:21:07Z |
| format | Article |
| id | doaj.art-9e4c7ccf619c424f89d26f4f6d787a0d |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-12-10T23:21:07Z |
| publishDate | 2022-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-9e4c7ccf619c424f89d26f4f6d787a0d2022-12-22T01:29:43ZengWileyESC Heart Failure2055-58222022-08-01942455246310.1002/ehf2.13942Days alive and out of hospital after left ventricular assist device implantationSebastian Roth0René M'Pembele1Alexandra Stroda2Josephine Voit3Giovanna Lurati Buse4Stephan U. Sixt5Ralf Westenfeld6Amin Polzin7Philipp Rellecke8Igor Tudorache9Markus W. Hollmann10Udo Boeken11Payam Akhyari12Artur Lichtenberg13Ragnar Huhn14Hug Aubin15Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf Heinrich‐Heine‐University Duesseldorf Duesseldorf GermanyDepartment of Anesthesiology, Medical Faculty and University Hospital Duesseldorf Heinrich‐Heine‐University Duesseldorf Duesseldorf GermanyDepartment of Anesthesiology, Medical Faculty and University Hospital Duesseldorf Heinrich‐Heine‐University Duesseldorf Duesseldorf GermanyDepartment of Anesthesiology, Medical Faculty and University Hospital Duesseldorf Heinrich‐Heine‐University Duesseldorf Duesseldorf GermanyDepartment of Anesthesiology, Medical Faculty and University Hospital Duesseldorf Heinrich‐Heine‐University Duesseldorf Duesseldorf GermanyDepartment of Anesthesiology, Medical Faculty and University Hospital Duesseldorf Heinrich‐Heine‐University Duesseldorf Duesseldorf GermanyDepartment of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty and University Hospital Duesseldorf Heinrich‐Heine‐University Duesseldorf Duesseldorf GermanyDepartment of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty and University Hospital Duesseldorf Heinrich‐Heine‐University Duesseldorf Duesseldorf GermanyDepartment of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf Heinrich‐Heine‐University Duesseldorf Moorenstr. 5 Duesseldorf 40225 GermanyDepartment of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf Heinrich‐Heine‐University Duesseldorf Moorenstr. 5 Duesseldorf 40225 GermanyDepartment of Anesthesiology Amsterdam University Medical Center (AUMC), Location AMC Amsterdam The NetherlandsDepartment of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf Heinrich‐Heine‐University Duesseldorf Moorenstr. 5 Duesseldorf 40225 GermanyDepartment of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf Heinrich‐Heine‐University Duesseldorf Moorenstr. 5 Duesseldorf 40225 GermanyDepartment of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf Heinrich‐Heine‐University Duesseldorf Moorenstr. 5 Duesseldorf 40225 GermanyDepartment of Anesthesiology, Medical Faculty and University Hospital Duesseldorf Heinrich‐Heine‐University Duesseldorf Duesseldorf GermanyDepartment of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf Heinrich‐Heine‐University Duesseldorf Moorenstr. 5 Duesseldorf 40225 GermanyAbstract Aims Implantation of left ventricular assist devices (LVADs) as a bridge to transplant or as destination therapy is increasing. The selection of suitable patients and outcome assessment belong to the key challenges. Mortality has traditionally been a focus of research in this field, but literature on quality of life is very limited. This study aimed to identify perioperative factors influencing patients' life as measured by days alive and out of hospital (DAOH) in the first year after LVAD implantation. Methods and results This retrospective single‐centre cohort study screened 227 patients who underwent LVAD implantation at the University Hospital Duesseldorf, Germany, between 2010 and 2020. First, the influence of 10 prespecified variables on DAOH was investigated by univariate analysis. Second, multivariate quantile regression was conducted including all factors with significant influence on DAOH in the univariate model. Additionally, the impact of all variables on 1 year mortality was investigated using Kaplan–Meier curves to oppose DAOH and mortality. In total, 221 patients were included into analysis. As pre‐operative factors, chronic kidney disease (CKD), pre‐operative mechanical circulatory support (pMCS), and Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) stadium < 3 were associated with lower DAOH at 1 year [CKD: 280 (155–322) vs. 230 (0–219), P = 0.0286; pMCS: 294 (155–325) vs. 243 (0–293), P = 0.0004; INTERMACS 1: 218 (0–293) vs. INTERMACS 2: 264 (6–320) vs. INTERMACS 3: 299 (228–325) vs. INTERMACS 4: 313 (247–332), P ≤ 0.0001]. Intra‐operative additional implantation of a right ventricular assist device (RVAD) was also associated with lower DAOH [RVAD: 290 (160–325) vs. 174 (0–277), P ≤ 0.0001]. As post‐operative values that were associated with lower DAOH, dialysis and tracheotomy could be identified [dialysis: 300 (252–326) vs. 186 (0–300), P ≤ 0.0001; tracheotomy: 292 (139–325) vs. 168 (0–269), P ≤ 0.0001]. Multivariate analysis revealed that all of these factors besides pMCS were independently associated with DAOH. According to Kaplan–Meier analysis, only post‐operative dialysis was significantly associated with increased mortality at 1 year (survival: no dialysis 89.4% vs. dialysis 70.1%, hazard ratio: 0.56, 95% confidence interval: 0.33–0.94; P = 0.031). Conclusions The results of this study indicate that there can be a clear discrepancy between hard endpoints such as mortality and more patient‐centred outcomes reflecting life impact. DAOH may relevantly contribute to a more comprehensive selection process and outcome assessment in LVAD patients.https://doi.org/10.1002/ehf2.13942Heart failureCardiac surgeryQuality of lifeMechanical circulatory supportPatient‐centred outcomes |
| spellingShingle | Sebastian Roth René M'Pembele Alexandra Stroda Josephine Voit Giovanna Lurati Buse Stephan U. Sixt Ralf Westenfeld Amin Polzin Philipp Rellecke Igor Tudorache Markus W. Hollmann Udo Boeken Payam Akhyari Artur Lichtenberg Ragnar Huhn Hug Aubin Days alive and out of hospital after left ventricular assist device implantation ESC Heart Failure Heart failure Cardiac surgery Quality of life Mechanical circulatory support Patient‐centred outcomes |
| title | Days alive and out of hospital after left ventricular assist device implantation |
| title_full | Days alive and out of hospital after left ventricular assist device implantation |
| title_fullStr | Days alive and out of hospital after left ventricular assist device implantation |
| title_full_unstemmed | Days alive and out of hospital after left ventricular assist device implantation |
| title_short | Days alive and out of hospital after left ventricular assist device implantation |
| title_sort | days alive and out of hospital after left ventricular assist device implantation |
| topic | Heart failure Cardiac surgery Quality of life Mechanical circulatory support Patient‐centred outcomes |
| url | https://doi.org/10.1002/ehf2.13942 |
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