Long-term follow-up of continuous flow left ventricular assist devices: Complications and predisposing risk factors

Tolulope A. Adesiyun, Rhondalyn C. McLean, Ryan J. Tedford, Glenn Whitman, Chris M. Sciortino, John V. Conte, Ashish S. Shah, Stuart D. Russell

Research output: Contribution to journalArticle

Abstract

Purpose: To assess LVAD complications and their overall effect on mortality and determine factors associated with development of early and longe-trm complications. Methods: A retrospective cohort study of patients who underwent continuous flow LVAD placement between January 1, 2000 and November 30, 2013 was performed. The incidence of complications (sepsis or bacteremia, driveline infections, gastrointestinal bleeding, pump thrombosis, cerebrovascular accidents and anemia requiring transfusion) was collected and logistic regression and Cox proportional hazards analyses were performed. Results: 108 patients met our inclusion criteria. Median length of follow-up was 2.2 years. In univariable logistic regression analysis, higher blood urea nitrogen (BUN), creatinine clearance <60, no prior inotrope use, higher INTERMACS class and lower platelet count were associated with early complications. On multivariable analysis, factors associated with early complications included higher BUN (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.001-1.06 per mg/dL BUN), no prior inotrope use (OR 4.92, 95% CI1.64-14.7) and lower platelet count (OR 4.29, 95% CI 1.45-12.7 <200 10(3) cu mm); 24% of patients developed early complications and 18.5% developed an early and late complication. Early complications were significantly associated with death (p = 0.017). The presence of 2 or more complications was associated with a 2.7-fold increase in the odds of death (p = 0.016) and odds of death increased by 20% with each susbequent complication (p = 0.004). Conclusions: LVADs are associated with significant long-term complications including stroke and sepsis and minimizing time on VLADs may decrease the risk of ocmplications and subsequent morbidity and moratlity.

Original languageEnglish (US)
Pages (from-to)622-628
Number of pages7
JournalInternational Journal of Artificial Organs
Volume40
Issue number11
DOIs
StatePublished - 2017

Fingerprint

Left ventricular assist devices
Heart-Assist Devices
Blood Urea Nitrogen
Urea
Causality
Blood
Nitrogen
Odds Ratio
Platelets
Platelet Count
Logistics
Sepsis
Logistic Models
Stroke
Confidence Intervals
Factor analysis
Bacteremia
Regression analysis
Anemia
Creatinine

Keywords

  • Complications
  • Heart afilure
  • Left ventricular assist device
  • LVAD
  • Mechanical support

ASJC Scopus subject areas

  • Bioengineering
  • Medicine (miscellaneous)
  • Biomaterials
  • Biomedical Engineering

Cite this

Long-term follow-up of continuous flow left ventricular assist devices : Complications and predisposing risk factors. / Adesiyun, Tolulope A.; McLean, Rhondalyn C.; Tedford, Ryan J.; Whitman, Glenn; Sciortino, Chris M.; Conte, John V.; Shah, Ashish S.; Russell, Stuart D.

In: International Journal of Artificial Organs, Vol. 40, No. 11, 2017, p. 622-628.

Research output: Contribution to journalArticle

Adesiyun, Tolulope A. ; McLean, Rhondalyn C. ; Tedford, Ryan J. ; Whitman, Glenn ; Sciortino, Chris M. ; Conte, John V. ; Shah, Ashish S. ; Russell, Stuart D. / Long-term follow-up of continuous flow left ventricular assist devices : Complications and predisposing risk factors. In: International Journal of Artificial Organs. 2017 ; Vol. 40, No. 11. pp. 622-628.
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abstract = "Purpose: To assess LVAD complications and their overall effect on mortality and determine factors associated with development of early and longe-trm complications. Methods: A retrospective cohort study of patients who underwent continuous flow LVAD placement between January 1, 2000 and November 30, 2013 was performed. The incidence of complications (sepsis or bacteremia, driveline infections, gastrointestinal bleeding, pump thrombosis, cerebrovascular accidents and anemia requiring transfusion) was collected and logistic regression and Cox proportional hazards analyses were performed. Results: 108 patients met our inclusion criteria. Median length of follow-up was 2.2 years. In univariable logistic regression analysis, higher blood urea nitrogen (BUN), creatinine clearance <60, no prior inotrope use, higher INTERMACS class and lower platelet count were associated with early complications. On multivariable analysis, factors associated with early complications included higher BUN (odds ratio (OR) 1.03, 95{\%} confidence interval (CI) 1.001-1.06 per mg/dL BUN), no prior inotrope use (OR 4.92, 95{\%} CI1.64-14.7) and lower platelet count (OR 4.29, 95{\%} CI 1.45-12.7 <200 10(3) cu mm); 24{\%} of patients developed early complications and 18.5{\%} developed an early and late complication. Early complications were significantly associated with death (p = 0.017). The presence of 2 or more complications was associated with a 2.7-fold increase in the odds of death (p = 0.016) and odds of death increased by 20{\%} with each susbequent complication (p = 0.004). Conclusions: LVADs are associated with significant long-term complications including stroke and sepsis and minimizing time on VLADs may decrease the risk of ocmplications and subsequent morbidity and moratlity.",
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T1 - Long-term follow-up of continuous flow left ventricular assist devices

T2 - Complications and predisposing risk factors

AU - Adesiyun, Tolulope A.

AU - McLean, Rhondalyn C.

AU - Tedford, Ryan J.

AU - Whitman, Glenn

AU - Sciortino, Chris M.

AU - Conte, John V.

AU - Shah, Ashish S.

AU - Russell, Stuart D.

PY - 2017

Y1 - 2017

N2 - Purpose: To assess LVAD complications and their overall effect on mortality and determine factors associated with development of early and longe-trm complications. Methods: A retrospective cohort study of patients who underwent continuous flow LVAD placement between January 1, 2000 and November 30, 2013 was performed. The incidence of complications (sepsis or bacteremia, driveline infections, gastrointestinal bleeding, pump thrombosis, cerebrovascular accidents and anemia requiring transfusion) was collected and logistic regression and Cox proportional hazards analyses were performed. Results: 108 patients met our inclusion criteria. Median length of follow-up was 2.2 years. In univariable logistic regression analysis, higher blood urea nitrogen (BUN), creatinine clearance <60, no prior inotrope use, higher INTERMACS class and lower platelet count were associated with early complications. On multivariable analysis, factors associated with early complications included higher BUN (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.001-1.06 per mg/dL BUN), no prior inotrope use (OR 4.92, 95% CI1.64-14.7) and lower platelet count (OR 4.29, 95% CI 1.45-12.7 <200 10(3) cu mm); 24% of patients developed early complications and 18.5% developed an early and late complication. Early complications were significantly associated with death (p = 0.017). The presence of 2 or more complications was associated with a 2.7-fold increase in the odds of death (p = 0.016) and odds of death increased by 20% with each susbequent complication (p = 0.004). Conclusions: LVADs are associated with significant long-term complications including stroke and sepsis and minimizing time on VLADs may decrease the risk of ocmplications and subsequent morbidity and moratlity.

AB - Purpose: To assess LVAD complications and their overall effect on mortality and determine factors associated with development of early and longe-trm complications. Methods: A retrospective cohort study of patients who underwent continuous flow LVAD placement between January 1, 2000 and November 30, 2013 was performed. The incidence of complications (sepsis or bacteremia, driveline infections, gastrointestinal bleeding, pump thrombosis, cerebrovascular accidents and anemia requiring transfusion) was collected and logistic regression and Cox proportional hazards analyses were performed. Results: 108 patients met our inclusion criteria. Median length of follow-up was 2.2 years. In univariable logistic regression analysis, higher blood urea nitrogen (BUN), creatinine clearance <60, no prior inotrope use, higher INTERMACS class and lower platelet count were associated with early complications. On multivariable analysis, factors associated with early complications included higher BUN (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.001-1.06 per mg/dL BUN), no prior inotrope use (OR 4.92, 95% CI1.64-14.7) and lower platelet count (OR 4.29, 95% CI 1.45-12.7 <200 10(3) cu mm); 24% of patients developed early complications and 18.5% developed an early and late complication. Early complications were significantly associated with death (p = 0.017). The presence of 2 or more complications was associated with a 2.7-fold increase in the odds of death (p = 0.016) and odds of death increased by 20% with each susbequent complication (p = 0.004). Conclusions: LVADs are associated with significant long-term complications including stroke and sepsis and minimizing time on VLADs may decrease the risk of ocmplications and subsequent morbidity and moratlity.

KW - Complications

KW - Heart afilure

KW - Left ventricular assist device

KW - LVAD

KW - Mechanical support

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