Impact of preoperative liver dysfunction on outcomes in patients with left ventricular assist devices

Yunus C. Yalcin, Yunus C. Yalcin, Rahatullah Muslem, Rahatullah Muslem, Kevin M. Veen, Osama I. Soliman, Olivier C. Manintveld, Sarwa Darwish Murad, Ahmet Kilic, Alina A. Constantinescu, Jasper J. Brugts, Fatimah Alkhunaizi, Ozcan Birim, Ryan J. Tedford, Ad J.J.C. Bogers, Steven Hsu, Kadir Caliskan

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

OBJECTIVES: We evaluated the impact of preoperative liver function on early and 1-year postoperative outcomes in patients supported with a left ventricular assist device (LVAD) and subsequent evolution of liver function markers. METHODS: A retrospective multicentre cohort study was conducted, including all patients undergoing continuous-flow LVAD implantation. The Model for End-stage Liver Disease (MELD) score was used to define liver dysfunction. RESULTS: Overall, 290 patients with an LVAD [78% HeartMate II, 15% HVAD and 7% HeartMate 3, mean age 55 (18), 76% men] were included. Over 40 000 measurements of liver function markers were collected over a 1-year period. A receiver operating characteristic curve analysis for the 1-year mortality rate identified the optimal cut-off value of 12.6 for the MELD score. Therefore, the cohort was dichotomized into patients with an MELD score of less than or greater than 12.6. The early (90-day) survival rates in patients with and without liver dysfunction were 76% and 91% (P = 0.002) and 65% and 90% at 1 year, respectively (P < 0.001). Furthermore, patients with preoperative liver dysfunction had more embolic events and more re-explorations. At the 1-year follow-up, liver function markers showed an overall improvement in the majority of patients, with or without pre-LVAD liver dysfunction. CONCLUSIONS: Preoperative liver dysfunction is associated with higher early 90-day and 1-year mortality rates after LVAD implantation. Furthermore, liver function improved in both patient groups. It has become imperative to optimize the selection criteria for possible LVAD candidates, since those who survive the first year show excellent recovery of their liver markers.

Original languageEnglish (US)
Pages (from-to)920-928
Number of pages9
JournalEuropean Journal of Cardio-thoracic Surgery
Volume57
Issue number5
DOIs
StatePublished - May 1 2020

Keywords

  • End-stage heart failure
  • Left ventricular assist device
  • Liver function
  • Model for End-stage Liver Disease

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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