Causes of death vary over time after LVAD implantation

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - The causes of death after left ventricular assist device (LVAD) implantation vary according to how much time has passed since the procedure, a new study suggests.

"The knowledge of what conditions patients are dying from at what time intervals may allow us to focus care more greatly in those areas in order to prevent them from occurring," said lead author Dr. John M. Stulak of the Mayo Clinic College of Medicine in Rochester, Minnesota.

"We may end up treating patients differently if we know that, during a particular period, they are at higher risk of dying from a certain complication," he told Reuters Health by email. "For instance, when patients bleed, they are removed from their blood thinners and then because of this alteration in blood thinning, they are at higher risk of stroke."

Dr. Stulak and his colleagues identified a cohort of patients who had undergone a continuous-flow LVAD implantation. Over almost 10 years at two academic medical centers, 395 male and 98 female patients, ranging in age from 18 to 79 years with a median of 60, had the device implanted.

Thirty-eight percent of the patients had the VAD implanted as destination therapy (DT) and the remainder as a bridge to transplantation (BTT).

Half had an ischemic cause of heart failure, the researchers report in The Annals of Thoracic Surgery, online April 10.

There were 132 deaths during a median of 5.5 years of follow-up: 26% occurred within 30 days of hospitalization or during the index hospitalization; 22% between hospital release and six month; 11% between six months and one year; and 42% after one year.

The most common causes of death in the early period were cardiac (62%) and neurologic (21%); between hospital release and six months, they were neurologic (31%), cardiac (17%) and device-related (11%); between six months and one year, they were neurologic (43%) and cardiac (22%); and after one year, they were neurologic (35%), cardiac (20%) and infectious (15%).

The causes of death also differed between patients in the BTT and DT groups.

Roughly half of the deaths were in the DT group. The median interval from LVAD implantation to death in these patients was 9.7 months, whereas in the BTT group it was 6.4 months.

Dr. Stulak said the data are based on two research centers, but that three more centers were later added and they now have over 1,100 LVAD patients in their database.

"The power of this collaboration lies not only in the large numbers of LVADs we have implanted during the past 10 years, but that it is a multicenter effort, so practice differences and variations can be studied," he said.

"The actual reasons WHY patients are dying from these conditions during these particular time intervals are yet to be investigated and we plan to look at this in a more detailed fashion," he added.

The study findings were presented at the Sixtieth Annual Meeting of the Southern Thoracic Surgical Association in 2013.

One of the authors reported having financial relationships with HeartWare and Thoratec, while the remainder did not declare any conflicts of interest.

SOURCE: http://bit.ly/1dANVwf

Ann Thorac Surg 2015.

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