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Outcomes in patients with advanced heart failure and small body size undergoing continuous-flow left ventricular assist device implantation

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Abstract

Left ventricular assist devices (LVADs) have become a preferred treatment option for patients with end-stage heart failure when used as a bridge to transplant or as a destination therapy. However, the association between small body size and postoperative outcomes for continuous-flow (CF) LVAD recipients is still being studied. We sought to determine whether body surface area (BSA) is associated with patient outcomes after CF-LVAD implantation. The study cohort of our single-center, retrospective review consisted of all patients (n = 526) who underwent CF-LVAD implantation (n = 403 HeartMate II, n = 123 HeartWare) between November 2003 and March 2016 regardless of indication. Patients were stratified into 2 cohorts according to their BSA measurements: small BSA (<1.5 m2, n = 13) and non-small BSA (≥1.5 m2, n = 513). We compared the survival of the small-BSA cohort with that of the non-small-BSA cohort. Patients with a small BSA had lower survival rates at 1, 6, 12, and 24 months (76.9, 61.5, 53.8, and 38.5%, respectively) than did patients with a non-small BSA (90.4, 80.9, 74.7, and 67.6% respectively; overall, p = 0.004). Cox proportional hazard analysis showed that a small BSA was an independent predictor of postoperative mortality (hazard ratio = 0.22, 95% confidence interval = 0.05–0.97, p < 0.04). These findings highlight the adverse impact of a small BSA on outcomes after CF-LVAD implantation.

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References

  1. Lee CH, Wei J. Successful continuous-flow left ventricular assist device implantation with adjuvant tricuspid valve repair for advanced heart failure. Cardiovasc J Afr. 2016;27:e14–e6.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Butler J, Howser R, Portner PM, Pierson RN. 3rd. Body mass index and outcomes after left ventricular assist device placement. Ann Thorac Surg. 2005;79:66–73.

    Article  PubMed  Google Scholar 

  3. Lietz K, Long J, Kfoury AG, Slaughter MS, Silver MA, Milano CA, Rogers JG, Naka Y, Mancini D, Miller LW. Outcomes of left ventricular assist device implantation as destination therapy in the post-REMATCH era: implications for patient selection. Circulation. 2007;116:497–505.

    Article  PubMed  Google Scholar 

  4. Russell S, Slaughter M, Pagani F, Moore S, Idrissi K, Klodell C. HeartMate II LVAS: Patient Management Guidelines. https://www.fda.gov/ohrms/dockets/ac/07/briefing/2007-4333b2-20-%209_4%20HM%20II%20Patient%20Management%20Guidelines.pdf. Accessed 24 Apr 2017.

  5. Fraser CD Jr, Jaquiss RD, Rosenthal DN, Humpl T, Canter CE, Blackstone EH, et al. Prospective trial of a pediatric ventricular assist device. N Engl J Med. 2012;367:532–41.

    Article  CAS  PubMed  Google Scholar 

  6. Lee S, Katz JN, Jorde UP, Moazami N, John R, Sundareswaran KS, et al. Outcomes of adult patients with small body size supported with a continuous-flow left ventricular assist device. ASAIO J. 2016;62:646 – 51.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Oz MC, Goldstein DJ, Pepino P, Weinberg AD, Thompson SM, Catanese KA, et al. Screening scale predicts patients successfully receiving long-term implantable left ventricular assist devices. Circulation. 1995;92:II169–73.

    Article  CAS  PubMed  Google Scholar 

  8. Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003;16:777–802.

    Article  PubMed  Google Scholar 

  9. Goldstein DJ. Worldwide experience with the MicroMed DeBakey Ventricular Assist Device as a bridge to transplantation. Circulation. 2003;108(Suppl 1):II272-7.

    PubMed  Google Scholar 

  10. Kirklin JK, Naftel DC, Pagani FD, Kormos RL, Stevenson L, Miller M, et al. Long-term mechanical circulatory support (destination therapy): on track to compete with heart transplantation? J Thorac Cardiovasc Surg. 2012;144:584–603 (discussion 597–8).

    Article  PubMed  PubMed Central  Google Scholar 

  11. Haghi D, Suselbeck T, Saur J. Aortic regurgitation during left ventricular assist device support. J Heart Lung Transpl. 2007;26:1220–1.

    Article  Google Scholar 

  12. Slaughter MS, Pagani FD, Rogers JG, Miller LW, Sun B, Russell SD, et al. Clinical management of continuous-flow left ventricular assist devices in advanced heart failure. J Heart Lung Transpl. 2010;29:S1-S39.

    Google Scholar 

  13. Ono M, Sawa Y, Nakatani T, Tominaga R, Matsui Y, Yamazaki K, et al. Japanese multicenter outcomes with the HeartMate II left ventricular assist device in patients with small bBody surface area. Circ J. 2016;80:1931–6.

    Article  PubMed  Google Scholar 

  14. Boyle AJ, Jorde UP, Sun B, Park SJ, Milano CA, Frazier OH, Sundareswaran KS, Farrar DJ, Russell SD. Pre-operative risk factors of bleeding and stroke during left ventricular asisst device support. J Am Col Cardiol. 2014;63:880–8.

    Article  Google Scholar 

  15. Saptharishi LG, Jayashree M, Singhi S. Development and validation of the “Pediatric Risk of Nosocomial Sepsis (PRiNS)” score for health care-associated infections in a medical pediatric intensive care unit of a developing economy—a prospective observational cohort study. J Crit Care. 2016;32:152–8.

    Article  CAS  PubMed  Google Scholar 

  16. Feldman D, Pamboukian SV, Teuteberg JJ, Birks E, Lietz K, Moore SA, et al. The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: executive summary. J Heart Lung Transpl. 2013;32:157 – 87.

    Article  Google Scholar 

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Acknowledgements

The authors thank Drs. MacArthur A. Elayda and Suwei Wang of the Department of Biostatistics and Epidemiology at the Texas Heart Institute for their timely help in analyzing our large dataset. The Section of Scientific Publications at the Texas Heart Institute provided editorial support.

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Correspondence to Chitaru Kurihara or Jeffrey A. Morgan.

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Volkovicher, N., Kurihara, C., Critsinelis, A. et al. Outcomes in patients with advanced heart failure and small body size undergoing continuous-flow left ventricular assist device implantation. J Artif Organs 21, 31–38 (2018). https://doi.org/10.1007/s10047-017-0988-z

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  • DOI: https://doi.org/10.1007/s10047-017-0988-z

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