Etiology and Timing of Hospital Readmissions following Magnetically Levitated LVAD Implantation

Objectives: The number of patients provided with a continuous flow left ventricular assist device (LVAD) is steadily increasing and these patients require very close medical follow-up given their risk for severe complications. Survival and quality of life are very important for these patients. Unplanned readmissions after LVAD implantation may be a significant burden for patients. Therefore the aim of this study was to characterize unplanned LVAD readmissions by reason and timing of readmission.

Methods: Data were collected for 80 patients who underwent newer generation magnetically levitated continuous flow LVAD implantation (HeartWare HVAD or BerlinHeart Incor or HeartMate III) between June 2013 and May 2017 and were followed up in our outpatient care unit (exclusion criteria: pulsatile VAD, RVAD implantation, early mortality before discharge, BTT without discharge between VAD and HTx). The cause of readmission, timing after LVAD implantation, and length of hospital stay were evaluated.

Results: During study analysis, thirty-seven patients had no unplanned readmissions after LVAD implantation (46.2%), while 43 of all 80 analyzed patients were readmitted 69 times (1.6 times/patient) until the end of follow up (cut off 09/15/2017). The median follow up after LVAD implantation was 19.3 months (range 80–1639 days). Unplanned LVAD-related readmissions were for assist device associated infections (23.2%), neurological events (18% stroke or ICB), bleeding complications, e.g., hemorrhage or gastrointestinal (17.4%), and device thrombosis (17.4%). Other causes included non-device related infections (15.9%). The 1^st event leading to unplanned readmission occurred in 76.7% within the 1^st year after LVAD implantation. The median time to first readmission after LVAD discharge was 7.2 months.

Conclusion: These data demonstrate that bleeding and infection events are the predominant reason for readmission after LVAD implantation. Multiple readmissions of a single patient with the same clinical pattern might bias the analysis. Interestingly when comparing with a previous analysis of our LVAD patients from 2010 until 2014, we could detect an increase of driveline infections and device thrombosis as reason for hospital readmission, while the rate of neurological events decreased in the current analysis. Further investigations of device specific complication rates in larger cohorts are necessary to characterize health care resource utilization after LVAD implantation.

No conflict of interest has been declared by the author(s).