Eisenga John B, McCullough Kyle A, Afzal Aasim, DiMaio J Michael, Moubarak Ghadi, Milligan Greg, Kabra Nitin, Rusia Akash, Rawitscher David A, George Timothy J
Baylor Scott and White, The Heart Hospital, Plano, Texas; Baylor Scott and White Research Institute, Dallas, Texas; Baylor University Medical Center, Dallas, Texas.
Baylor Scott and White, The Heart Hospital, Plano, Texas; Baylor Scott and White Research Institute, Dallas, Texas.
J Surg Res. 2025 Apr;308:202-208. doi: 10.1016/j.jss.2025.02.009. Epub 2025 Mar 21.
While left ventricular device implantation has been shown to improve both survival and quality of life in patients with end stage heart failure, these patients have a high rate of readmissions to the hospital. The incidence and factors associated with readmission are poorly characterized in the destination therapy population.
All patients who underwent HeartMate III left ventricular assist device therapy (LVAD) implantation at our facility from 2017 to 2023 were identified. Patients undergoing primary LVAD implantation were included. Primary outcome was readmission for any reason. Multivariable linear regression was utilized to identify predictors of readmissions.
From 2017 to 2023, 151 primary LVAD implantations were performed with 12 (8.0%) perioperative moralities (defined as index implant hospitalization mortality). The 139 remaining patients suffered 456 separate readmissions with a median follow-up of 590 (303-1002) ds and a total follow-up of 270.7 patient-ys for a rate of 1.7 readmissions per patient-y. The most common cause of readmission was heart failure exacerbation (27.0%), major infection (17.8%), and major bleeding (13.6%). Patients who were readmitted within 6 mos were more likely to have New York Heart Association class III or IV symptoms compared to those who had not been readmitted 39.1% versus 11.8% versus 15%, P = 0.0008. On multivariable linear regression, increasing body mass index (P = 0.02), increased preoperative bilirubin (P = 0.04), and increased follow-up time (P < 0.01) were predictive of the need for readmissions.
Following LVAD implantation, readmissions within 6 mos of surgery are associated with worse functional status at 6 mos and 1 y postoperatively. Increased body mass index and preoperative bilirubin were associated with more frequent readmissions.
虽然已证明左心室装置植入可改善终末期心力衰竭患者的生存率和生活质量，但这些患者再次入院的比率很高。在目标治疗人群中，再入院的发生率及相关因素的特征尚不明确。
确定了2017年至2023年期间在我们机构接受HeartMate III左心室辅助装置治疗（LVAD）植入的所有患者。纳入接受初次LVAD植入的患者。主要结局是因任何原因再次入院。采用多变量线性回归来确定再入院的预测因素。
2017年至2023年期间，共进行了151例初次LVAD植入手术，其中12例（8.0%）发生围手术期死亡（定义为初次植入住院死亡率）。其余139例患者共发生456次单独的再入院，中位随访时间为590（303 - 1002）天，总随访时间为270.7患者年，即每位患者每年再入院率为1.7次。再入院的最常见原因是心力衰竭加重（27.0%）、严重感染（17.8%）和严重出血（13.6%）。与未再入院的患者相比，6个月内再入院的患者更有可能出现纽约心脏协会III级或IV级症状（39.1%对11.8%对15%，P = 0.0008）。在多变量线性回归分析中，体重指数增加（P = 0.02）、术前胆红素升高（P = 0.04）和随访时间延长（P < 0.01）是再入院需求的预测因素。
LVAD植入术后，术后6个月内的再入院与术后6个月和1年时较差的功能状态相关。体重指数增加和术前胆红素升高与更频繁的再入院相关。
