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Kyriakopoulos CP, Selzman CH, Giannouchos TV, Mylavarapu R, Sideris K, Elmer A, Vance N, Hanff TC, Kagawa H, Stehlik J, Drakos SG, Goodwin ML. Hospital Readmissions in Patients Supported with Durable Centrifugal-Flow Left Ventricular Assist Devices. J Clin Med 2024; 13:2869. [PMID: 38792411 PMCID: PMC11122328 DOI: 10.3390/jcm13102869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Centrifugal-flow left ventricular assist devices (CF-LVADs) have improved morbidity and mortality for their recipients. Hospital readmissions remain common, negatively impacting quality of life and survival. We sought to identify risk factors associated with hospital readmissions among patients with CF-LVADs. Methods: Consecutive patients receiving a CF-LVAD between February 2011 and March 2021 were retrospectively evaluated using prospectively maintained institutional databases. Hospital readmissions within three years post-LVAD implantation were dichotomized into heart failure (HF)/LVAD-related or non-HF/LVAD-related readmissions. Multivariable Cox regression models augmented using a machine learning algorithm, the least absolute shrinkage and selection operator (LASSO) method, for variable selection were used to estimate associations between HF/LVAD-related readmissions and pre-, intra- and post-operative clinical variables. Results: A total of 204 CF-LVAD recipients were included, of which 138 (67.7%) had at least one HF/LVAD-related readmission. HF/LVAD-related readmissions accounted for 74.4% (436/586) of total readmissions. The main reasons for HF/LVAD-related readmissions were major bleeding, major infection, HF exacerbation, and neurological dysfunction. Using pre-LVAD variables, HF/LVAD-related readmissions were associated with substance use, previous cardiac surgery, HF duration, pre-LVAD inotrope dependence, percutaneous LVAD/VA-ECMO support, LVAD type, and the left ventricular ejection fraction in multivariable analysis (Harrell's concordance c-statistic; 0.629). After adding intra- and post-operative variables in the multivariable model, LVAD implant hospitalization length of stay was an additional predictor of readmission. Conclusions: Using machine learning-based techniques, we generated models identifying pre-, intra-, and post-operative variables associated with a higher likelihood of rehospitalizations among patients on CF-LVAD support. These models could provide guidance in identifying patients with increased readmission risk for whom clinical strategies to mitigate this risk may further improve LVAD recipient outcomes.
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Affiliation(s)
- Christos P. Kyriakopoulos
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health and School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (K.S.); (T.C.H.); (J.S.); (S.G.D.)
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA; (C.H.S.); (R.M.); (A.E.); (N.V.); (H.K.)
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Craig H. Selzman
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA; (C.H.S.); (R.M.); (A.E.); (N.V.); (H.K.)
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT 84112, USA
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health and School of Medicine, Salt Lake City, UT 84132, USA
| | - Theodoros V. Giannouchos
- Department of Health Policy & Organization, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Rohan Mylavarapu
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA; (C.H.S.); (R.M.); (A.E.); (N.V.); (H.K.)
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health and School of Medicine, Salt Lake City, UT 84132, USA
| | - Konstantinos Sideris
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health and School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (K.S.); (T.C.H.); (J.S.); (S.G.D.)
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA; (C.H.S.); (R.M.); (A.E.); (N.V.); (H.K.)
| | - Ashley Elmer
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA; (C.H.S.); (R.M.); (A.E.); (N.V.); (H.K.)
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health and School of Medicine, Salt Lake City, UT 84132, USA
| | - Nathan Vance
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA; (C.H.S.); (R.M.); (A.E.); (N.V.); (H.K.)
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health and School of Medicine, Salt Lake City, UT 84132, USA
| | - Thomas C. Hanff
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health and School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (K.S.); (T.C.H.); (J.S.); (S.G.D.)
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA; (C.H.S.); (R.M.); (A.E.); (N.V.); (H.K.)
| | - Hiroshi Kagawa
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA; (C.H.S.); (R.M.); (A.E.); (N.V.); (H.K.)
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health and School of Medicine, Salt Lake City, UT 84132, USA
| | - Josef Stehlik
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health and School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (K.S.); (T.C.H.); (J.S.); (S.G.D.)
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA; (C.H.S.); (R.M.); (A.E.); (N.V.); (H.K.)
| | - Stavros G. Drakos
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health and School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (K.S.); (T.C.H.); (J.S.); (S.G.D.)
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA; (C.H.S.); (R.M.); (A.E.); (N.V.); (H.K.)
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Matthew L. Goodwin
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA; (C.H.S.); (R.M.); (A.E.); (N.V.); (H.K.)
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health and School of Medicine, Salt Lake City, UT 84132, USA
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Schachl J, Stoiber M, Socha M, Zimpfer D, Wiedemann D, Schima H, Schlöglhofer T. Mechanical Characterization of Anchoring Devices for the Prevention of Driveline Infection in Left Ventricular Assist Device Patients. ASAIO J 2024; 70:249-256. [PMID: 38081043 DOI: 10.1097/mat.0000000000002111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Driveline infection (DLI) is associated with increased mortality and morbidity in left ventricular assist device (LVAD) patients. Because trauma to the driveline exit-site (DLES) is a risk factor for DLI, adhesive anchoring devices are used to immobilize the DL. In this study, commonly used products (identified through literature review and contact with nine international VAD implantation centers) were mechanically characterized to evaluate their effectiveness in preventing DLES trauma. Eight devices were tested in an in vitro abdominal model of the DLES, where a tensile force (10 N) was applied to a HeartMate 3 DL, whereas the resulting force ( FTotal ) on the DLES was recorded using a three-axis load cell. Four devices (CathGrip: FTotal = 2.1 ± 0.4 N, Secutape: FTotal = 2.6 ± 0.3 N, Hollister: FTotal = 2.7 ± 0.5 N, Tubimed: FTotal = 2.9 ± 0.2 N) were significantly ( p < 0.05) better at preventing tensile forces at the DLES compared to the other four devices (Main-Lock: FTotal = 3.7 [0.7] N, Secutape sensitive: FTotal = 3.9 ± 0.4 N, Foley Anchor: FTotal = 4.3 ± 0.5 N, Grip-Lok: FTotal = 5.4 ± 0.8 N). Immobilization of the DL with each anchoring device resulted in lower tensile force on the DLES than without an anchor ( FTotal = 8.2 ± 0.3 N). In conclusion, the appropriate selection of anchoring devices plays a critical role in reducing the risk of DLI, whereas the CathGrip, Secutape, Hollister, or Tubimed were superior in preventing trauma to the DLES in this study.
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Affiliation(s)
- Johanna Schachl
- From the Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Stoiber
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
| | - Martina Socha
- From the Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniel Zimpfer
- From the Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Dominik Wiedemann
- From the Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Heinrich Schima
- From the Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
| | - Thomas Schlöglhofer
- From the Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
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Rodenas-Alesina E, Brahmbhatt DH, Mak S, Ross HJ, Luk A, Rao V, Billia F. Value of Invasive Hemodynamic Assessments in Patients Supported by Continuous-Flow Left Ventricular Assist Devices. JACC. HEART FAILURE 2024; 12:16-27. [PMID: 37804313 DOI: 10.1016/j.jchf.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/14/2023] [Accepted: 08/22/2023] [Indexed: 10/09/2023]
Abstract
Left ventricular assist devices (LVADs) are increasingly used in patients with end-stage heart failure (HF). There is a significant risk of HF admissions and hemocompatibility-related adverse events that can be minimized by optimizing the LVAD support. Invasive hemodynamic assessment, which is currently underutilized, allows personalization of care for patients with LVAD, and may decrease the need for recurrent hospitalizations. It also aids in triaging patients with persistent low-flow alarms, evaluating reversal of pulmonary vasculature remodeling, and assessing right ventricular function. In addition, it can assist in determining the precipitant for residual HF symptoms and physical limitation during exercise and is the cornerstone of the assessment of myocardial recovery. This review provides a comprehensive approach to the use of invasive hemodynamic assessments in patients supported with LVADs.
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Affiliation(s)
- Eduard Rodenas-Alesina
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Darshan H Brahmbhatt
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Mount Sinai Hospital, Toronto Ontario, Canada
| | - Susanna Mak
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Mount Sinai Hospital, Toronto Ontario, Canada
| | - Heather J Ross
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Adriana Luk
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vivek Rao
- Division of Cardiac Surgery, Peter Munk Cardiac Center, University Health Network, Toronto, Ontario, Canada
| | - Filio Billia
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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