Risk factors for adverse outcomes after left ventricular assist device implantation and extracorporeal cardiopulmonary resuscitation

摘要

Left ventricular assist device implantation following extracorporeal cardiopulmonary resuscitation has been associated with ambivalent results. In a series of patients who underwent left ventricular assist device implantation after extracorporeal cardiopulmonary resuscitation, we investigated whether the outcome can be predicted by preoperative risk factors or established risk scores. Primary endpoint was a composite of mortality and severe neurological disabling over 1 year of follow-up. To assess predictors of the primary endpoint, we performed univariate and multivariable Cox regression analyses. Of the 40 patients included, 24 patients (60%) experienced the primary endpoint. Renal replacement therapy and the Vasoactive-Inotropic Score were independently associated regarding the primary endpoint with a hazard ratio for renal replacement therapy of 2.50 (95% confidence interval: 1.09-5.70; P = 0.021) and for the Vasoactive-Inotropic Score of 1.02 per unit (95% confidence interval: 1.00-1.03; P = 0.040). The risk of experiencing an unfavorable outcome during follow-up in patients with a Vasoactive-Inotropic Score of 20 who needed renal replacement therapy or did not need renal replacement therapy was 78% and 54%, respectively. Our data indicate that a decision to implant a left ventricular assist device in patients requiring renal replacement therapy and revealing a high Vasoactive-Inotropic Score after extracorporeal cardiopulmonary resuscitation should be reached with caution.