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Severity of End-Organ Damage as a Predictor of Outcomes After Implantation of Left Ventricular Assist Device

Authors :
Walter E. Pae
Zachary C. Landis
Behzad Soleimani
Edward R. Stephenson
Aly El-Banayosy
Source :
ASAIO Journal. 61:127-132
Publication Year :
2015
Publisher :
Ovid Technologies (Wolters Kluwer Health), 2015.

Abstract

The optimal timing of left ventricular assist device (LVAD) implantation in the management of advanced heart failure remains controversial. We hypothesize that in patients with cardiogenic shock, the severity of end-organ dysfunction as determined by the sequential organ failure assessment (SOFA) score is a determinant of outcomes after LVAD implantation. We determined the preoperative SOFA score and short- and long-term outcomes of 97 consecutive patients who received HeartMate II or HeartWare LVAD at our institution since January 2007. Kaplan-Meier analysis was used to compare long-term survival across SOFA score subgroups. The overall 30 day mortality was 10.1%, with no significant difference among SOFA score subgroups. Patients with scores ≥9 had significantly longer hospital stay (26 ± 6 vs. 18 ± 10 days, p = 0.03). One-year survival for SOFA scores 0-2, 3-5, 6-8, and ≥9 was 94%, 75%, 64%, and 29%, respectively. SOFA score was significantly lower in survivors at 6, 9, 12, 24, and 36 months. SOFA score did not predict adverse outcomes of bleeding, cerebrovascular events, infection, or pump exchange. These results show that preoperative SOFA score is a powerful predictor of outcomes after LVAD implantation. Long-term outcomes can be significantly improved by early intervention before emergence of end-organ dysfunction.

Details

ISSN :
10582916
Volume :
61
Database :
OpenAIRE
Journal :
ASAIO Journal
Accession number :
edsair.doi.dedup.....a535d55aba2cd12cf78253b78adcadbb
Full Text :
https://doi.org/10.1097/mat.0000000000000185