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Intensive Care Medicine
Published in: Intensive Care Medicine 7/2020

Open Access 01-07-2020 | Septicemia | Original

Causes and predictors of early mortality in patients treated with left ventricular assist device implantation in the European Registry of Mechanical Circulatory Support (EUROMACS)

Authors: Sakir Akin, Osama Soliman, Theo M. M. H. de By, Rahatullah Muslem, Jan G. P. Tijssen, Felix Schoenrath, Bart Meyns, Jan F. Gummert, Paul Mohacsi, Kadir Caliskan, the EUROMACS investigators

Published in: Intensive Care Medicine | Issue 7/2020

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Abstract

Purpose

The aim of the study was to analyze early mortality after continuous-flow left ventricular assist device (LVAD) implantation which remains high.

Methods

We analyzed consecutive (n = 2689) patients from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) undergoing continuous-flow LVAD implantation. The primary outcome was early (< 90 days) mortality. Secondary outcomes were differential causes of early post-operative death following LVAD implantation.

Results

Univariable and multivariable analysis as well as regression analysis were used to examine determinants and differential causes of early (< 90 days) mortality after LVAD implantation. During the first 90 days, 2160 (80%) patients were alive with ongoing LVAD support, 40(2%) patients underwent heart transplantation, and 487(18%) deceased. The main causes of early death were MOF (36%), sepsis (28%), cardiopulmonary failure (CPF; 10%), CVA (9%), and right-sided heart failure (RHF, 8%). Furthermore, MOF and sepsis are 70% of causes of death in the first week. Independent clinical predictors of early death were age, female sex, INTERMACS profile 1 to 3, and ECMO. Laboratory predictors included elevated serum creatinine, total bilirubin, lactate, and low hemoglobin. Furthermore, hemodynamic predictors included elevated RA-to-PCWP ratio, pulmonary vascular resistance, and low systemic vascular resistance. Longer total implantation time was also independent predictor of early mortality. A simple model of 12 variables predicts early mortality following LVAD implantation with a good discriminative power with area under the curve of 0.75.

Conclusions

In the EUROMACS registry, approximately one out of five patients die within 90 days after LVAD implantation. Early mortality is primarily dominated by multiorgan failure followed by sepsis. A simple model identifies important parameters which are associated with early mortality following LVAD implantation.
Appendix
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Metadata
Title
Causes and predictors of early mortality in patients treated with left ventricular assist device implantation in the European Registry of Mechanical Circulatory Support (EUROMACS)
Authors
Sakir Akin
Osama Soliman
Theo M. M. H. de By
Rahatullah Muslem
Jan G. P. Tijssen
Felix Schoenrath
Bart Meyns
Jan F. Gummert
Paul Mohacsi
Kadir Caliskan
the EUROMACS investigators
Publication date
01-07-2020
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 7/2020
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-020-05939-1

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