Eltawansy Sherif, Ahmed Faizan, Sharma Grishma, Masood Areehah Zafar, Chandrani Naazmin, Hossein Mohammad, Patel Swapnil, Khunkhun Ravitej, Jain Hritvik, Ahmed Mushood, Ahmed Raheel, Bhat Adnan, Asmi Nisar, Aman Kainat, Heaton Joseph, Almendral Jesus
Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, New Jersey, USA.
Division of Cardiology, Duke University Hospital, Durham, North Carolina, USA.
Artif Organs. 2025 Jul;49(7):1197-1206. doi: 10.1111/aor.14989. Epub 2025 Mar 19.
INTRODUCTION: Approximately 5%-10% of heart failure (HF) patients progress to advanced stages. Left ventricular assist devices (LVADs) have emerged as a favored therapy for end-stage HF as destination therapy or as a bridge to heart transplantation. However, complications and provider expertise hinder their widespread use. To address this, the third-generation LVAD was introduced in late 2018 to enhance usability and reduce complications. We aimed to investigate the temporal trends in post-LVAD complications with the newest generation LVAD versus the previous version. METHODS: We utilized the 2016-2020 Nationwide Readmission Database to identify patients ≥ 18 years of age with advanced HF implanted with an LVAD. Variables were determined using the International Classification of Diseases, Tenth revision codes. We compared patients through all years individually. In addition, we created two groups based on the implant year (2016-2018 and 2019-2020). The primary outcome was 30-day readmission, while secondary outcomes were complications and mortality rates. Multivariate analyses and descriptive bivariate analyses were performed. A value of p < 0.05 was considered statistically significant. RESULTS: We identified 7975 patients (21.3% females), of which 17.1% (n = 1214) were readmitted within 30 days. Readmission rates were 18% (n = 778) for 2016-2018 and 16% (n = 435) for 2019-2020 (adjusted Wald test, p = 0.26). The 2019-2020 group exhibited a reduction in cardiac device complications (p = 0.024), cardiac tamponade (p = 0.009), and periprocedural circulatory complications (p = 0.014) in subgroup comparison (2016-2018 vs. 2019-2020). Despite these improvements, the mortality rate and hospital stay did not differ significantly between the two periods. No significant differences in mortality or LOS were observed between the two groups (adjusted Wald test, p > 0.05 in both). CONCLUSIONS: Complications following LVAD placement continue to impede its broader adoption for advanced HF. Advancements in newer LVAD technology and improved provider expertise hold promise for increased utilization. Our study indicated a decline in some complications, including cardiac tamponade and cardiac device complications, including periprocedural circulatory ones, which may be attributed to newer device innovations. Further research is necessary to explore this correlation in greater depth.
引言：约5%-10%的心力衰竭（HF）患者会进展至晚期。左心室辅助装置（LVAD）已成为终末期HF的一种首选治疗方法，可作为目标治疗或心脏移植的桥梁。然而，并发症和医疗人员的专业技能阻碍了其广泛应用。为解决这一问题，第三代LVAD于2018年末推出，以提高其易用性并减少并发症。我们旨在研究最新一代LVAD与上一版本相比，LVAD术后并发症的时间趋势。 方法：我们利用2016-2020年全国再入院数据库，识别年龄≥18岁、植入LVAD的晚期HF患者。变量通过国际疾病分类第十版编码确定。我们逐年对患者进行比较。此外，我们根据植入年份（2016-2018年和2019-2020年）创建了两组。主要结局是30天再入院情况，次要结局是并发症和死亡率。进行了多变量分析和描述性双变量分析。p值<0.05被认为具有统计学意义。 结果：我们识别出7975例患者（21.3%为女性），其中17.1%（n = 1214）在30天内再次入院。2016-2018年的再入院率为18%（n = 778），2019-2020年为16%（n = 435）（校正Wald检验，p = 0.26）。在亚组比较（2016-2018年与2019-2020年）中，2019-2020年组的心脏装置并发症（p = 0.024）、心脏压塞（p = 0.009）和围手术期循环并发症（p = 0.014）有所减少。尽管有这些改善，但两个时期的死亡率和住院时间并无显著差异。两组之间在死亡率或住院时间方面未观察到显著差异（校正Wald检验，两者p均>0.05）。 结论：LVAD植入后的并发症继续阻碍其在晚期HF中的更广泛应用。更新的LVAD技术进步和医疗人员专业技能的提高有望提高其利用率。我们的研究表明，包括心脏压塞和心脏装置并发症（包括围手术期循环并发症）在内的一些并发症有所减少，这可能归因于更新的装置创新。有必要进行进一步研究以更深入地探索这种相关性。
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