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L2. ADVANCED AGE, FEMALE GENDER, DIABETES MELLITUS, AND PREOPERATIVE MALNUTRITION PREDICT POOR OUTCOME IN PATIENTS WITH CHRONIC CONGESTIVE HEART FAILURE WHO UNDERGO LEFT VENTRICULAR ASSIST DEVICE IMPLANTATION
Nicholas C Dang, Veli K Topkara, Brian T Kim, Michelle L Mercando, Joy Kay, Timothy P Martens, Isaac George, Faisal H Cheema, Yoshifumi Naka; New York, 630 West 168th Street, NY
Objective:
Use of left ventricular assist devices (LVADs) as a bridge to transplant for chronic congestive heart failure (CHF) patients is well accepted. Few studies have examined outcomes solely for these patients. This study details one center’s LVAD experience with this population.
Methods:
Two hundred one patients received HeartMate LVADs from 1/1/96 to 4/30/04. Of these, 59.2% had chronic CHF (diagnosis >6 months) as their primary indication. Outcome parameters included post-LVAD early mortality (14 days), bridge to transplant rate, and post-transplant survival rate. Variables examined included patient demographics, preoperative pacemaker, internal defibrillator, balloon pump, and preoperative laboratory values.
Results:
Advanced age, female gender, and diabetes were independent predictors of early mortality (p=0.048, OR 1.879 per 10 years of age, 95% CI 1.005-3.515; p=0.002, OR 10.029, 95% CI 2.256-44.583; p=0.040, OR 3.974, 95% CI 1.063-14.861). Advanced age, female gender, and low preoperative albumin were independent predictors of poor bridge rate (p=0.029, OR 0.135 per 10 years of age, 95% CI 0.022-0.819; p=0.002, OR 0.013, 95% CI 0.001-0.197; p=0.023, OR 19.178 per 1g/dl albumin, 95% CI 1.504-244.598). There were no independent predictors of poor post-transplant survival and prolonged ICU stay. Overall bridge rate was 76.8%. One-, three-, and five-year post-transplant survival rates were 88.4%, 84.5%, and 78.4%.
Conclusions:
In patients with chronic CHF, advanced age, female gender, diabetes, and low preoperative albumin predict poor clinical course. Careful patient selection, particularly of diabetics and the elderly, as well as preoperative nutritional optimization, should be encouraged to enhance patient outcomes.
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