Li Renxi, Prastein Deyanira J, Boyce Steven W
The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Division of Cardiothoracic Surgery, Department of Surgery, The George Washington University Hospital, Washington, DC, USA.
Artif Organs. 2025 Jun;49(6):1053-1061. doi: 10.1111/aor.14965. Epub 2025 Feb 3.
Left ventricular assist device (LVAD) implantation can be used to manage advanced heart failure. Debates over sex differences in postoperative outcomes of LVAD implantation remain contentious; there is limited evidence available from the continuous-flow era, particularly following the introduction of third-generation devices. This study aimed to conduct a comprehensive, contemporary, and population-based analysis of the sex difference in the in-hospital outcomes following LVAD implantations.
Patients who underwent LVAD implantation were selected from National Inpatient Sample from Q4 2015-2021. Multivariable logistic regression was used to compare in-hospital outcomes between females and males, where demographics, socioeconomic status, primary payer status, hospital characteristics, comorbidities, and transfer/admission status were adjusted.
There were 1201 (23.6%) female and 3881 (76.4%) male patients who underwent LVAD implantation. Females and males had comparable in-hospital mortality, MACE, and stroke. However, females had higher diaphragmatic paralysis (aOR = 7.94, 95 CI = 1.46-43.48, p = 0.02). Meanwhile, females had lower cardiogenic shock (aOR = 0.85, 95 CI = 0.73-0.98, p = 0.02), renal complications (aOR = 0.72, 95 CI = 0.62-0.84, p < 0.01), and infection (aOR = 0.70, 95 CI = 0.58-0.86, p < 0.01). Females also had longer hospital length of stay (44.1 ± 40.0 vs. 38.8 ± 30.6 days, p = 0.01) and higher total hospital charges (1293779.0 ± 1182139.0 vs. 1172780.0 ± 917544.0 US dollars, p = 0.04).
In the contemporary era with the introduction of third-generation devices, in-hospital mortality and stroke after LVAD implantation continued to decrease and were comparable in both sexes. However, there are still notable sex-based differences in the complications of LVAD implantation, which underscores the need for sex-specific preoperative risk assessments and tailored perioperative management.
左心室辅助装置（LVAD）植入可用于治疗晚期心力衰竭。关于LVAD植入术后结果的性别差异的争论仍然存在争议；在连续血流时代，尤其是在引入第三代装置后，可用证据有限。本研究旨在对LVAD植入术后住院结果的性别差异进行全面、当代和基于人群的分析。
从2015年第4季度至2021年的国家住院样本中选择接受LVAD植入的患者。使用多变量逻辑回归比较女性和男性的住院结果，并对人口统计学、社会经济地位、主要付款人状况、医院特征、合并症以及转诊/入院状况进行调整。
共有1201名（23.6%）女性和3881名（76.4%）男性患者接受了LVAD植入。女性和男性的住院死亡率、主要不良心血管事件（MACE）和中风发生率相当。然而，女性膈神经麻痹发生率较高（校正比值比[aOR]=7.94，95%置信区间[CI]=1.46-43.48，p=0.02）。同时，女性的心源性休克发生率较低（aOR=0.85，95%CI=0.73-0.98，p=0.02）、肾脏并发症发生率较低（aOR=0.72，95%CI=0.62-0.84，p<0.01）以及感染发生率较低（aOR=0.70，95%CI=0.58-0.86，p<0.01）。女性的住院时间也更长（44.1±40.0天 vs. 38.8±30.6天，p=0.01），总住院费用更高（1293779.0±1182139.0美元 vs. 1172780.0±917544.0美元，p=0.04）。
在引入第三代装置的当代，LVAD植入术后的住院死亡率和中风发生率持续下降，且两性相当。然而，LVAD植入并发症仍存在明显的性别差异，这突出了进行针对性别术前风险评估和定制围手术期管理的必要性。
