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Identifying Temporal Relationships Between In‐Hospital Adverse Events After Implantation of Durable Left Ventricular Assist Devices

BACKGROUND: This study evaluated the impact of adverse events (AEs) on the development of subsequent AEs after left ventricular assist device (LVAD) surgery. METHODS AND RESULTS: The INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) was used to identify primary durable L...

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Autores principales: Kilic, Arman, Seese, Laura, Pagani, Francis, Kormos, Robert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428534/
https://www.ncbi.nlm.nih.gov/pubmed/32285751
http://dx.doi.org/10.1161/JAHA.119.015449
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author Kilic, Arman
Seese, Laura
Pagani, Francis
Kormos, Robert
author_facet Kilic, Arman
Seese, Laura
Pagani, Francis
Kormos, Robert
author_sort Kilic, Arman
collection PubMed
description BACKGROUND: This study evaluated the impact of adverse events (AEs) on the development of subsequent AEs after left ventricular assist device (LVAD) surgery. METHODS AND RESULTS: The INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) was used to identify primary durable LVADs implanted between 2006 and 2016. The temporal relationships between AEs occurring during the index hospitalization were evaluated using separate risk‐adjusted Cox proportional hazard models. LVADs were implanted in 18 763 patients. The strongest positive relationships were renal failure leading to hepatic dysfunction (hazard ratio [HR], 6.62; 95% CI, 5.12–8.54; P<0.001), respiratory failure leading to renal failure (HR, 5.51; 95% CI, 4.79–6.34; P<0.001), respiratory failure leading to hepatic dysfunction (HR, 4.36; 95% CI, 3.25–5.83; P<0.001), renal failure leading to respiratory failure (HR, 4.18; 95% CI, 3.76–4.64; P<0.001), and renal failure leading to right ventricular assist device implant (HR, 3.70; 95% CI, 2.31–5.90; P<0.001). Although bleeding, infection, and right ventricular assist device implant were each associated with several subsequent AEs, the magnitude of association was less substantial. The lowest 1‐year post‐LVAD survival was associated with the primary AEs of renal failure (68.1%) and respiratory failure (70.7%) (log‐rank P<0.001). CONCLUSIONS: Most in‐hospital AEs after LVAD implantation have a significant association with the development of subsequent AEs, with the most profound impact associated with primary renal or respiratory failure, which are also associated with the lowest 1‐year survival. Targeting the reduction of renal or respiratory failure as the primary AE after LVAD surgery would likely yield the greatest reductions in overall AE burden and subsequent mortality.
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spelling pubmed-74285342020-08-17 Identifying Temporal Relationships Between In‐Hospital Adverse Events After Implantation of Durable Left Ventricular Assist Devices Kilic, Arman Seese, Laura Pagani, Francis Kormos, Robert J Am Heart Assoc Original Research BACKGROUND: This study evaluated the impact of adverse events (AEs) on the development of subsequent AEs after left ventricular assist device (LVAD) surgery. METHODS AND RESULTS: The INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) was used to identify primary durable LVADs implanted between 2006 and 2016. The temporal relationships between AEs occurring during the index hospitalization were evaluated using separate risk‐adjusted Cox proportional hazard models. LVADs were implanted in 18 763 patients. The strongest positive relationships were renal failure leading to hepatic dysfunction (hazard ratio [HR], 6.62; 95% CI, 5.12–8.54; P<0.001), respiratory failure leading to renal failure (HR, 5.51; 95% CI, 4.79–6.34; P<0.001), respiratory failure leading to hepatic dysfunction (HR, 4.36; 95% CI, 3.25–5.83; P<0.001), renal failure leading to respiratory failure (HR, 4.18; 95% CI, 3.76–4.64; P<0.001), and renal failure leading to right ventricular assist device implant (HR, 3.70; 95% CI, 2.31–5.90; P<0.001). Although bleeding, infection, and right ventricular assist device implant were each associated with several subsequent AEs, the magnitude of association was less substantial. The lowest 1‐year post‐LVAD survival was associated with the primary AEs of renal failure (68.1%) and respiratory failure (70.7%) (log‐rank P<0.001). CONCLUSIONS: Most in‐hospital AEs after LVAD implantation have a significant association with the development of subsequent AEs, with the most profound impact associated with primary renal or respiratory failure, which are also associated with the lowest 1‐year survival. Targeting the reduction of renal or respiratory failure as the primary AE after LVAD surgery would likely yield the greatest reductions in overall AE burden and subsequent mortality. John Wiley and Sons Inc. 2020-04-14 /pmc/articles/PMC7428534/ /pubmed/32285751 http://dx.doi.org/10.1161/JAHA.119.015449 Text en © 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Kilic, Arman
Seese, Laura
Pagani, Francis
Kormos, Robert
Identifying Temporal Relationships Between In‐Hospital Adverse Events After Implantation of Durable Left Ventricular Assist Devices
title Identifying Temporal Relationships Between In‐Hospital Adverse Events After Implantation of Durable Left Ventricular Assist Devices
title_full Identifying Temporal Relationships Between In‐Hospital Adverse Events After Implantation of Durable Left Ventricular Assist Devices
title_fullStr Identifying Temporal Relationships Between In‐Hospital Adverse Events After Implantation of Durable Left Ventricular Assist Devices
title_full_unstemmed Identifying Temporal Relationships Between In‐Hospital Adverse Events After Implantation of Durable Left Ventricular Assist Devices
title_short Identifying Temporal Relationships Between In‐Hospital Adverse Events After Implantation of Durable Left Ventricular Assist Devices
title_sort identifying temporal relationships between in‐hospital adverse events after implantation of durable left ventricular assist devices
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428534/
https://www.ncbi.nlm.nih.gov/pubmed/32285751
http://dx.doi.org/10.1161/JAHA.119.015449
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