Mortada Ibrahim, Kourek Christos, Kshetri Rupesh, Singhal Arun, Panos Anthony, Briasoulis Alexandros, Mhanna Mohammed, Mansour Shareef, Yumul Kristine, Alvarez Paulino, Ruiz Duque Ernesto
Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, Iowa.
Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece.
JHLT Open. 2024 Dec 13;7:100195. doi: 10.1016/j.jhlto.2024.100195. eCollection 2025 Feb.
The use of continuous flow left ventricular assist device (CF-LVAD) has revolutionized the management of advanced heart failure. One of the major complications associated with its use is the risk of bleeding, especially in the early postoperative period. Early events of postoperative bleeding have been associated with higher morbidity and mortality rates. Our study aims at identifying potential predictors of intraoperative bleeding, defined as 4 or more units of packed red blood cells transfused during surgery. A single-center retrospective cohort study of adult patients older than 18 years old who underwent CF-LVAD implantation between 2009 and 2024.
Data were collected for the duration of implant hospitalization, including perioperative invasive hemodynamics, echocardiography, operative details, mechanical circulatory support, antiplatelets, inotropes, bleeding events, and blood product use, in addition to patient history and baseline characteristics.
A total of 208 patients were included in the analysis. Intraoperative bleeding occurred in 43 (20.67%) patients while 165 (79.33%) patients did not experience bleeding. Multilogistic regression analysis showed that artery bypass grafting pre-LVAD (odds ratio [OR] 2.98, confidence interval [CI] 1.2-7.42, = 0.01) and temporary mechanical assist device pre-LVAD (OR 3.67, 95%CI 1.72-7.85, < 0.001) were independent predictors of intraoperative bleeding during hospitalization. Intraoperative bleeding is also correlated with worse clinical outcomes, higher 90-day mortality (hazard ratio [HR] 10.4, < 0.01, CI 95% 3.28-33.38) 206 subjects with 14 failures.
History of coronary artery bypass grafting and mechanical circulatory support before the implantation of LVAD are independent predictors of intraoperative bleeding during hospitalization in these patients. Intraoperative bleeding is associated with higher frequency of right ventricle failure post-LVAD and higher 90-day mortality.
连续流左心室辅助装置（CF-LVAD）的应用彻底改变了晚期心力衰竭的治疗方式。其使用相关的主要并发症之一是出血风险，尤其是在术后早期。术后早期出血事件与更高的发病率和死亡率相关。我们的研究旨在确定术中出血的潜在预测因素，术中出血定义为手术期间输注4个或更多单位的浓缩红细胞。对2009年至2024年间接受CF-LVAD植入的18岁以上成年患者进行单中心回顾性队列研究。
收集植入住院期间的数据，包括围手术期有创血流动力学、超声心动图、手术细节、机械循环支持、抗血小板药物、血管活性药物、出血事件和血液制品使用情况，以及患者病史和基线特征。
共有208例患者纳入分析。43例（20.67%）患者发生术中出血，165例（79.33%）患者未发生出血。多因素逻辑回归分析显示，LVAD植入前的动脉搭桥术（比值比[OR]2.98，置信区间[CI]1.2 - 7.42，P = 0.01）和LVAD植入前的临时机械辅助装置（OR 3.67，95%CI 1.72 - 7.85，P < 0.001）是住院期间术中出血的独立预测因素。术中出血也与更差的临床结局、更高的90天死亡率（风险比[HR]10.4，P < 0.01，95%CI 3.28 - 33.38）相关，206例受试者中有14例失败。
LVAD植入前的冠状动脉搭桥术史和机械循环支持是这些患者住院期间术中出血的独立预测因素。术中出血与LVAD植入后右心室衰竭的较高发生率和90天较高死亡率相关。
