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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...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2020
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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. |
format | Online Article Text |
id | pubmed-7428534 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
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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