Journal of cardiac surgery · 2006
Determinants of outcomes for postcardiotomy VAD placement: an 11-year, two-institution study.
Сравнительное исследованиеСтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Paul Subroto, Leacche Marzia, Unic Daniel, Couper Gregory S, Macgillivray Thomas E, Agnihotri Arvind K, Cohn Lawrence H, Byrne John G
Аннотация
OBJECTIVE: Ventricular assist device (VAD) placement after postcardiotomy failure is associated with a high mortality. We sought to determine prognostic factors in order to help better select patients who may benefit from VAD placement.
METHODS: From January 1992 to January 2003, 63 patients out of approximately 30,000 cardiac surgery patients (0.21%) developed postcardiotomy failure requiring VADs. Planned VAD for bridge to transplant or bridge to recovery were excluded. Multivariate logistic regression analysis, based on pre-VAD placement parameters, was used to determine prognostic factors for in-hospital 30-day mortality.
RESULTS: Overall operative mortality was 73% (46 of 63). Multivariate logistic regression analysis identified median age </=50 (each additional year) (OR = 0.85, 95% CI = 0.77 to 0.95, p = 0.004) and median base deficit >/=0 mEq/L (each additional mEq/L) prior to VAD placement (OR = 0.60, 95% CI = 0.48 to 0.91, p = 0.012) to be independent predictors of improved 30-day survival.
CONCLUSIONS: Postcardiotomy failure is a rare event but is associated with a very poor prognosis despite salvage therapies utilizing VADs. Age </=50 years and base deficit >/=0 (mEq/L) prior to VAD placement are associated with improved 30-day survival.
METHODS: From January 1992 to January 2003, 63 patients out of approximately 30,000 cardiac surgery patients (0.21%) developed postcardiotomy failure requiring VADs. Planned VAD for bridge to transplant or bridge to recovery were excluded. Multivariate logistic regression analysis, based on pre-VAD placement parameters, was used to determine prognostic factors for in-hospital 30-day mortality.
RESULTS: Overall operative mortality was 73% (46 of 63). Multivariate logistic regression analysis identified median age </=50 (each additional year) (OR = 0.85, 95% CI = 0.77 to 0.95, p = 0.004) and median base deficit >/=0 mEq/L (each additional mEq/L) prior to VAD placement (OR = 0.60, 95% CI = 0.48 to 0.91, p = 0.012) to be independent predictors of improved 30-day survival.
CONCLUSIONS: Postcardiotomy failure is a rare event but is associated with a very poor prognosis despite salvage therapies utilizing VADs. Age </=50 years and base deficit >/=0 (mEq/L) prior to VAD placement are associated with improved 30-day survival.