Association of timing of percutaneous left ventricular assist device insertion with outcomes in patients undergoing cardiac surgery

Jean-Luc A Maigrot; Randall C Starling; Ziad Taimeh; Michael Z Y Tong; Edward G Soltesz; Aaron J Weiss

doi:10.1016/j.xjon.2023.10.028

Association of timing of percutaneous left ventricular assist device insertion with outcomes in patients undergoing cardiac surgery

JTCVS Open. 2023 Oct 31:16:430-446. doi: 10.1016/j.xjon.2023.10.028. eCollection 2023 Dec.

Authors

Jean-Luc A Maigrot¹, Randall C Starling², Ziad Taimeh², Michael Z Y Tong¹, Edward G Soltesz¹, Aaron J Weiss¹

Affiliations

¹ Department of Thoracic and Cardiovascular Surgery, Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
² Department of Cardiovascular Medicine, Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.

Abstract

Objectives: The aim of this study was to explore the associations between percutaneous ventricular assist device (pVAD) insertion timing relative to cardiac surgery and patient outcomes.

Methods: The Nationwide Inpatient Sample was queried for patients undergoing cardiac surgery and pVAD insertion in the same admission from 2016 to 2019. Patients were stratified by timing of pVAD insertion. Preoperative characteristics, postoperative complications, and mortality were compared among groups.

Results: Overall, 3695 patients underwent cardiac surgery and pVAD insertion during the same hospitalization (pre: 1130, intra: 1690, and post: 875). The distribution of cardiac surgery procedures was similar across groups. Median Elixhauser Comorbidity Index was 13 for pre-, 15 for intra-, and 17 for postoperative pVAD patients (P = .021). Patients who received a postoperative pVAD were associated with increased mortality (pre: 18%, intra: 39%, and post: 54%; P < .01). Increased complication rates were also associated with postoperative pVAD insertion (pre: 61%, intra: 55%, and post: 75%; P < .01). Preoperative pVAD insertion was associated with increase rates of sepsis (pre: 18%, intra: 9.8%, and post: 17%; P = .01) and pneumonia (pre: 38%, intra: 23%, and post: 31%; P < .01). Postoperative pVAD insertion was associated with increased rates of gastrointestinal bleeding (pre: 2.2%, intra: 3.0%, and post: 7.4%; P = .01), renal failure (pre: 10%, intra: 9.2%, and post: 17%; P = .01), and prolonged ventilation (pre: 44%, intra: 41%, and post: 54%; P = .02).

Conclusions: Postoperative pVAD insertion following cardiac surgery was associated with increased complications and mortality compared with preoperative or intraoperative insertion. Further studies should explore optimal utilization and timing of pVAD insertion in patients undergoing cardiac surgery.

Keywords: Impella; Impella-assisted cardiac surgery; national database; outcomes; temporary mechanical circulatory support; transvalvular microaxial pump.