Early adverse events as predictors of 1-year mortality during mechanical circulatory support

J Heart Lung Transplant. 2010 Sep;29(9):981-8. doi: 10.1016/j.healun.2010.04.014. Epub 2010 Jul 1.


Background: Ventricular assist devices (VADs) provide effective treatment for end-stage heart failure; however, most patients experience > or =1 major adverse events (AEs) while on VAD support. Although early, non-fatal AEs may increase the risk of later death during VAD support, this relationship has not been established. Therefore, we sought to determine the impact on 1-year mortality of AEs occurring during the first 60 days of VAD support.

Methods: A retrospective analysis was performed using prospectively collected data from a single-site database for patients aged > or =18 years receiving left ventricular or biventricular support during 1996 to 2008 and who survived >60 days on VAD support. Fourteen major classes of AEs occurring during this 60-day period were examined. One-year survival rates of patients with and without each major AE were compared.

Results: The study included 163 patients (80% men; mean age, 49.5 years), of whom 87% were European American, 72% had left ventricular support, and 83% were bridge to transplant. The occurrence of renal failure, respiratory failure, bleeding events, and reoperations during the first 60 days after implantation significantly increased the risk of 1-year mortality. After controlling for gender, age, VAD type, and intention to treat, renal failure was the only major AE significantly associated with later mortality (hazard ratio, 2.96; p = .023).

Conclusions: Specific AEs, including renal failure, respiratory and bleeding events, and reoperations, significantly decrease longer-term survival. Renal failure conferred a 3-fold increased risk of 1-year mortality. Peri-operative management should focus on strategies to mitigate risk for renal failure in order to maximize later outcomes.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Equipment Design
  • Female
  • Heart Failure / mortality
  • Heart Failure / surgery*
  • Heart Transplantation / mortality
  • Heart Transplantation / statistics & numerical data
  • Heart-Assist Devices* / adverse effects
  • Hemorrhage / etiology
  • Humans
  • Infections / etiology
  • Kidney Diseases / etiology
  • Male
  • Middle Aged
  • Respiratory Tract Diseases / etiology
  • Retrospective Studies
  • Risk Factors
  • Survival Rate
  • Treatment Failure
  • Treatment Outcome
  • Young Adult