Risk factors for adverse outcomes after left ventricular assist device implantation and extracorporeal cardiopulmonary resuscitation

Abstract

Left ventricular assist device implantation following extracorporeal cardiopulmonary resuscitation has been associated with ambivalent results. In a series of patients who underwent left ventricular assist device implantation after extracorporeal cardiopulmonary resuscitation, we investigated whether the outcome can be predicted by preoperative risk factors or established risk scores. Primary endpoint was a composite of mortality and severe neurological disabling over 1 year of follow-up. To assess predictors of the primary endpoint, we performed univariate and multivariable Cox regression analyses. Of the 40 patients included, 24 patients (60%) experienced the primary endpoint. Renal replacement therapy and the Vasoactive-Inotropic Score were independently associated regarding the primary endpoint with a hazard ratio for renal replacement therapy of 2.50 (95% confidence interval: 1.09–5.70; P = 0.021) and for the Vasoactive-Inotropic Score of 1.02 per unit (95% confidence interval: 1.00–1.03; P = 0.040). The risk of experiencing an unfavorable outcome during follow-up in patients with a Vasoactive-Inotropic Score of 20 who needed renal replacement therapy or did not need renal replacement therapy was 78% and 54%, respectively. Our data indicate that a decision to implant a left ventricular assist device in patients requiring renal replacement therapy and revealing a high Vasoactive-Inotropic Score after extracorporeal cardiopulmonary resuscitation should be reached with caution.

Keywords

Left ventricular assist device extracorporeal cardiopulmonary resuscitation risk score mortality survival neurological disabling

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References

Ortega-Deballon

Hornby

Shemie

et al . Extracorporeal resuscitation for refractory out-of-hospital cardiac arrest in adults: a systematic review of international practices and outcomes. Resuscitation 2016; 101: 12–20.

Aubin

Petrov

Dalyanoglu

et al . Suprainstitutional network for remote extracorporeal life support: a retrospective cohort study. JACC Heart Fail 2016; 4: 698–708.

Spartera

Jabbour

Chiarito

et al . Stepwise use of circulatory support devices in a patient refractory to cardiopulmonary resuscitation. Cardiovasc Revasc Med 2017; 18(6): 447–449.

Ljajikj

Zittermann

Koster

et al . Extracorporeal resuscitation as a further modifier of clinical outcome in patients with left ventricular assist device implantation and Interagency Registry for Mechanically Assisted Circulatory Support level 1. Interact Cardiovasc Thorac Surg 2018; 27: 139–141.

Kirklin

Naftel

Pagani

et al . INTERMACS annual report: 15,000 patients and counting. J Heart Lung Transplant 2015; 34: 1495–1504.

Kanwar

Lohmueller

Kormos

et al . Low accuracy of the heartmate risk score for predicting mortality using the INTERMACS registry data. ASAIO J 2017; 63(3): 251–256.

Adamo

Nassif

Tibrewala

et al . The Heartmate Risk Score predicts morbidity and mortality in unselected left ventricular assist device recipients and risk stratifies INTERMACS class 1 patients. JACC Heart Fail 2015; 3(4): 283–290.

Hofmann

Gmelin

Metz

et al . Cardiac surgery score (CASUS) improves outcome prediction in patients treated with extracorporal life support (ECLS). Perfusion 2018; 33: 36–43.

Chung

Cho

et al . Vasoactive inotropic score as a predictor of mortality in adult patients with cardiogenic shock: medical therapy versus ECMO. Rev Esp Cardiol (Engl Ed) 2019; 72(1): 40–47.

10.

Deo

Al-Kindi

Altarabsheh

et al . Model for end-stage liver disease excluding international normalized ratio (MELD-XI) score predicts heart transplant outcomes: evidence from the registry of the united network for organ sharing. J Heart Lung Transplant 2016; 35(2): 222–227.

11.

Matthews

JC1

Pagani

Haft

et al . Model for end-stage liver disease score predicts left ventricular assist device operative transfusion requirements, morbidity, and mortality. Circulation 2010; 121(2): 214–220.

12.

Ajam

Gold

Beck

et al . Reliability of the cerebral performance category to classify neurological status among survivors of ventricular fibrillation arrest: a cohort study. Scand J Trauma Resusc Emerg Med 2011; 19: 38.

13.

Kim

Jung

Park

et al . An optimal transition time to extracorporeal cardiopulmonary resuscitation for predicting good neurological outcome in patients with out-of-hospital cardiac arrest: a propensity-matched study. Crit Care 2014; 18(5): 535.

14.

Waseem

Chen

PH.

Hypoxic hepatitis: a review and clinical update. J Clin Transl Hepatol 2016; 4(3): 263–268.

15.

Khorsandi

Dougherty

Bouamra

et al . Extra-corporeal membrane oxygenation for refractory cardiogenic shock after adult cardiac surgery: a systematic review and meta-analysis. J Cardiothorac Surg 2017; 12(1): 55.

16.

Haft

Pagani

Romano

et al . Short- and long-term survival of patients transferred to a tertiary care center on temporary extracorporeal circulatory support. Ann Thorac Surg 2009; 88(3): 711–717.

17.

Den Uil

Akin

Jewbali

et al . Short-term mechanical circulatory support as a bridge to durable left ventricular assist device implantation in refractory cardiogenic shock: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2017; 52(1): 14–25.