Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Cardiovascular Surgery
Predictor of Early Mortality for Severe Heart Failure Patients With Left Ventricular Assist Device Implantation
– Significance of INTERMACS Level and Renal Function –
Daisuke YoshiokaTaichi SakaguchiShunsuke SaitoShigeru MiyagawaHiroyuki NishiYasushi YoshikawaSatsuki FukushimaTetsuya SaitoTakashi DaimonTakayoshi UenoToru KurataniYoshiki Sawa
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2012 Volume 76 Issue 7 Pages 1631-1638


Background: The preoperative risk factors for left ventricular assist device (LVAD) implantation and their impact on the clinical outcome was analyzed to evaluate the optimal timing of LVAD implantation for severe heart failure patients. Methods and Results: From January 2006 to August 2011, 82 patients underwent 84 LVAD implantations at the Osaka University Hospital. These patients were categorized into 2 groups: Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level 1 (n=41) and INTERMACS level 2/3 (n=43). The preoperative characteristics, early mortality, and cumulative survival between the 2 groups was compared. Ten (24.4%) patients died within 90 days in the INTERMACS level 1 group (multiple organ failure: 6, cerebrovascular event: 3, sepsis: 1), whereas 1 (2.3%) patient died because of a cerebrovascular event in the INTERMACS level 2/3 group (P=0.003). The cumulative survival rate was 82.9% at 30 days, 75.6% at 90 days, and 63.7% after 1 year in the INTERMACS level 1 group, and 100%, 97.7%, and 85.3% in the level 2/3 group (P=0.015). Using multivariate analysis for the INTERMACS level 1 group data, the preoperative serum creatinine level was the independent predictor of 90-day mortality. Conclusions: LVAD implantation in a stable condition contributes to better clinical outcome for severe heart failure patients. If critical cardiogenic shock occurs, LVAD implantation must be considered immediately before other organs' functions, especially renal function, deteriorate.  (Circ J 2012; 76: 1631–1638)

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