• Sakir Akin, Osama Soliman, Theo M M H de By, Rahatullah Muslem, Tijssen Jan G P JGP Amsterdam University Medical Centers-University of Amsterdam, Amsterdam, The Netherlands. , Felix Schoenrath, Bart Meyns, Jan F Gummert, Paul Mohacsi, Kadir Caliskan, and EUROMACS investigators.
• Thoraxcenter, Department of Cardiology, Erasmus MC University Medical Centre Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
• Intensive Care Med. 2020 Jul 1; 46 (7): 1349-1360.

PurposeThe aim of the study was to analyze early mortality after continuous-flow left ventricular assist device (LVAD) implantation which remains high.MethodsWe analyzed consecutive (n = 2689) patients from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) undergoing continuous-flow LVAD implantation. The primary outcome was early (< 90 days) mortality. Secondary outcomes were differential causes of early post-operative death following LVAD implantation.ResultsUnivariable and multivariable analysis as well as regression analysis were used to examine determinants and differential causes of early (< 90 days) mortality after LVAD implantation. During the first 90 days, 2160 (80%) patients were alive with ongoing LVAD support, 40(2%) patients underwent heart transplantation, and 487(18%) deceased. The main causes of early death were MOF (36%), sepsis (28%), cardiopulmonary failure (CPF; 10%), CVA (9%), and right-sided heart failure (RHF, 8%). Furthermore, MOF and sepsis are 70% of causes of death in the first week. Independent clinical predictors of early death were age, female sex, INTERMACS profile 1 to 3, and ECMO. Laboratory predictors included elevated serum creatinine, total bilirubin, lactate, and low hemoglobin. Furthermore, hemodynamic predictors included elevated RA-to-PCWP ratio, pulmonary vascular resistance, and low systemic vascular resistance. Longer total implantation time was also independent predictor of early mortality. A simple model of 12 variables predicts early mortality following LVAD implantation with a good discriminative power with area under the curve of 0.75.ConclusionsIn the EUROMACS registry, approximately one out of five patients die within 90 days after LVAD implantation. Early mortality is primarily dominated by multiorgan failure followed by sepsis. A simple model identifies important parameters which are associated with early mortality following LVAD implantation.

13 keywords...

hide…