PMID- 32285751
OWN - NLM
STAT- MEDLINE
DCOM- 20210308
LR  - 20210308
IS  - 2047-9980 (Electronic)
IS  - 2047-9980 (Linking)
VI  - 9
IP  - 8
DP  - 2020 Apr 21
TI  - Identifying Temporal Relationships Between In-Hospital Adverse Events After 
      Implantation of Durable Left Ventricular Assist Devices.
PG  - e015449
LID - 10.1161/JAHA.119.015449 [doi]
LID - e015449
AB  - Background This study evaluated the impact of adverse events (AEs) on the 
      development of subsequent AEs after left ventricular assist device (LVAD) 
      surgery. Methods and Results The INTERMACS (Interagency Registry for Mechanically 
      Assisted Circulatory Support) was used to identify primary durable LVADs 
      implanted between 2006 and 2016. The temporal relationships between AEs occurring 
      during the index hospitalization were evaluated using separate risk-adjusted Cox 
      proportional hazard models. LVADs were implanted in 18 763 patients. The 
      strongest positive relationships were renal failure leading to hepatic 
      dysfunction (hazard ratio [HR], 6.62; 95% CI, 5.12-8.54; P<0.001), respiratory 
      failure leading to renal failure (HR, 5.51; 95% CI, 4.79-6.34; P<0.001), 
      respiratory failure leading to hepatic dysfunction (HR, 4.36; 95% CI, 3.25-5.83; 
      P<0.001), renal failure leading to respiratory failure (HR, 4.18; 95% CI, 
      3.76-4.64; P<0.001), and renal failure leading to right ventricular assist device 
      implant (HR, 3.70; 95% CI, 2.31-5.90; P<0.001). Although bleeding, infection, and 
      right ventricular assist device implant were each associated with several 
      subsequent AEs, the magnitude of association was less substantial. The lowest 
      1-year post-LVAD survival was associated with the primary AEs of renal failure 
      (68.1%) and respiratory failure (70.7%) (log-rank P<0.001). Conclusions Most 
      in-hospital AEs after LVAD implantation have a significant association with the 
      development of subsequent AEs, with the most profound impact associated with 
      primary renal or respiratory failure, which are also associated with the lowest 
      1-year survival. Targeting the reduction of renal or respiratory failure as the 
      primary AE after LVAD surgery would likely yield the greatest reductions in 
      overall AE burden and subsequent mortality.
FAU - Kilic, Arman
AU  - Kilic A
AD  - Division of Cardiac Surgery University of Pittsburgh Medical Center Pittsburgh 
      PA.
FAU - Seese, Laura
AU  - Seese L
AD  - Division of Cardiac Surgery University of Pittsburgh Medical Center Pittsburgh 
      PA.
FAU - Pagani, Francis
AU  - Pagani F
AD  - Department of Cardiac Surgery University of Michigan Ann Arbor MI.
FAU - Kormos, Robert
AU  - Kormos R
AD  - Division of Cardiac Surgery University of Pittsburgh Medical Center Pittsburgh 
      PA.
LA  - eng
PT  - Journal Article
DEP - 20200414
PL  - England
TA  - J Am Heart Assoc
JT  - Journal of the American Heart Association
JID - 101580524
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Databases, Factual
MH  - Female
MH  - Heart Failure/mortality/physiopathology/*therapy
MH  - *Heart-Assist Devices
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - North America
MH  - Prosthesis Implantation/*adverse effects/*instrumentation/mortality
MH  - Registries
MH  - Renal Insufficiency/*epidemiology/mortality
MH  - Respiratory Insufficiency/*epidemiology/mortality
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - Ventricular Function, Left
MH  - Young Adult
PMC - PMC7428534
OTO - NOTNLM
OT  - complications
OT  - heart failure
OT  - left ventricular assist device
EDAT- 2020/04/15 06:00
MHDA- 2021/03/09 06:00
PMCR- 2020/04/21
CRDT- 2020/04/15 06:00
PHST- 2020/04/15 06:00 [pubmed]
PHST- 2021/03/09 06:00 [medline]
PHST- 2020/04/15 06:00 [entrez]
PHST- 2020/04/21 00:00 [pmc-release]
AID - JAH35000 [pii]
AID - 10.1161/JAHA.119.015449 [doi]
PST - ppublish
SO  - J Am Heart Assoc. 2020 Apr 21;9(8):e015449. doi: 10.1161/JAHA.119.015449. Epub 
      2020 Apr 14.