When LVAD implantation is too late – predictors of hospital mortality post LVAD implant

Aims: Candidate selection for left ventricular assist device (LVAD) implantation is similar crucial as for heart transplantation. If the patient is too sick adequate LVAD flow will not affect the poor prognosis. We analyzed the preoperative risk factor profile of patients who died in-hospital following LVAD implantation.

Methods: Preoperative markers were sampled and analyzed with univariate analysis and receiver operated curves curves followed by multinomial logistic regression (MLR) with in-hospital mortality as the primary outcome.

Results: Between 2/1993 and 8/2010 a total of 244 patients received LVAD support. Patients with age<16y and primary biventricular support were excluded. In hospital mortality was 31%. Univariate analysis revealed 16 significant individual risk factors for in-hospital mortality. However, in the MLR only four parameters were significant for in-hospital mortality following LVAD implantation (Table).

Table 1: Multivariate analysis for in-hospital mortality

ECMO, extracorporeal membrane oxygenation; WBC, white blood cells
Values	p value	Odds ratio	95% CI
Lactate >2mg/dl	0.009	7.388	1.637–33.330
Previous sternotomy	0.050	7.364	1.962–56.365
On ECMO support	0.038	8.950	1.129–70.945
WBC >12mg/dl	0.001	12.369	2.749–55.655

Conclusion: The laboratory parameters lactate and WBC as marker for malperfusion and infection; and the patient condition with previous sternotomy and ECMO support as indicator for potential surgical complication affect significantly in-hospital mortality following LVAD implantation. Especially if the combinations of any of these parameters is present the patients might be too sick to receive LVAD support.