Extended LVAD Support Lowers Bleeding Risk, Raises Infection Risk

Extended left ventricular assist device (LVAD) support is associated with improved long-term survival and a decreased risk of major bleeds in patients who received cardiovascular surgery, according to a recent study. However, extended LVAD use was associated with an increased risk of infection.

Currently, the literature examining clinical outcomes and hospital readmissions during extended LVAD support is scarce.
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To further assess the outcomes associated with extended LVAD support, the researchers retrospectively evaluated 103 consecutive patients who had received LVAD support from June 2006 to March 2015, focusing specifically on those who had received support for more than 1 year.

Standard statistical methods were used to analyze patients’ demographic characteristics, and all readmissions were classified via the Interagency Registry for Mechanically Assisted Circulatory Support 2015 guidelines.

A total of 37 of 103 patients had received LVAD support for more than 1 year, with 18 of 37 receiving LVAD support for more than 2 years. Mean support time was 786 days, and total support time reached 80 patient-years. Over a median follow-up of 2 years, 27 patients had died, and 1-year conditional survival was 74%.

Median freedom from first readmission was 106 days, and average length of stay was 6 days. Hospital readmissions lasted a mean of 41 days. Reasons for readmission included major infection, major bleeding, and device malfunction or thrombus. A total of 112 procedures were performed during readmissions, with 5 (13%) patients receiving 60% of these procedures.

“Continuous-flow LVADs provide excellent long-term survival,” the researchers concluded. “The present study describes marked differences in reasons for readmissions between the general LVAD population and those supported for more than 1 year. Prolonged LVAD support resulted in decreased susceptibility to major bleeds and increased susceptibility to infection.”

—Christina Vogt

Reference:

Raju S, MacIver J, Foroutan F, Alba C, Billia F, Rao V. Long-term use of left ventricular assist devices: a report on clinical outcomes. Can J Surg. 2017;60(4):236-246. doi:10.1503/cjs.010016.