Author + information
- Katherine Lietza,b,
- Christopher Barreiroa,b,
- Jonathan Philpotta,b,
- Claudia Flinka,b,
- Michael McGratha,b and
- John Herrea,b
Background: Bleeding remains the most common adverse event of mechanical circulatory support (MCS) surgery. Stratification tools to determine risk of bleeding with MCS have not been developed.
Methods: We examined predictors of bleeding among clinical risk factors available to physicians at the time of decision to proceed with durable MCS. We studied 183 consecutive recipients of MCS between 1/1/09 and 6/30/15 (163 HeartMate II LVAD, 16 HeartWare HVAD, 7 total artificial heart) during the index hospitalization (median follow-up: 24 days). Perioperative bleeding was defined as blood loss requiring red blood cell product (RBCP) transfusion intra- and postoperatively. Logistic regression multivariable model was employed for analyzes.
Results: Overall, survival to discharge was 92.3%. The majority (85%) of patients required RBCP transfusions (mean 8.1+9 units). More than half of study patients experienced moderate (5-9 units, n=48, 26%) or severe bleeding (>9 units, n=52, 28%). By multivariable analysis the following parameters were identified as independent predictors of moderate-to-severe bleeding (> 4 units): planned concomitant valve and/or CABG surgery at time of LVAD (OR 4.4, CI 9-10.2)**, HeartMate 2 LVAD implant (OR 3.2, CI 1.1-9.6)*, patient age > 55 years (OR 3.5, CI 1.8-6.9)**, hemoglobin <11 g/dL (OR 2.4, CI 1.2-4.8)* and body surface area < 2.0 kg/m2 (OR 2.2, CI 1.1-4.5)*. Risk factors significant by univariate analysis which did not enter the multivariable model included: previous sternotomy*, ischemic cardiomyopathy*, HeartMate 2 Risk Score* and Child Pugh Risk Score*. Furthermore, we found direct relationship between the number of identified predictors of bleeding and the severity of perioperative bleeding**, need for surgical re-exploration**, length of hospital stay** and mortality prior to hospital discharge**. *p<.05, **p<.005.
Conclusions: Preoperative anemia is an important and potentially modifiable target for optimization in selected MCS candidates. Intrapericardial LVADs is a superior choice for patients at risk of bleeding, such as those of small body habitus, older age and anticipating concomitant surgery with LVAD implantation.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Heart Failure and Cardiomyopathies: What Next When All Else Is Failing?
Abstract Category: 14. Heart Failure and Cardiomyopathies: Therapy
Presentation Number: 1248-255
- 2017 American College of Cardiology Foundation