Prevalence, risk factors, and prognostic implications of intraoperative bleeding during CF-LVAD implant
Background: The use of continuous flow left ventricular assist device (CF-LVAD) has revolutionized the management of advanced heart failure. One of the major complications associated with its use is the risk of bleeding, especially in the early postoperative period. Early events of postoperative ble...
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Elsevier
2025-02-01
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| Series: | JHLT Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133424001447 |
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| author | Ibrahim Mortada, MD Christos Kourek, MD, PhD Rupesh Kshetri, MD Arun Singhal, MD Anthony Panos, MD Alexandros Briasoulis, MD, PhD Mohammed Mhanna, MD, MPH Shareef Mansour, MD Kristine Yumul, MD Paulino Alvarez, MD Ernesto Ruiz Duque, MD |
| author_facet | Ibrahim Mortada, MD Christos Kourek, MD, PhD Rupesh Kshetri, MD Arun Singhal, MD Anthony Panos, MD Alexandros Briasoulis, MD, PhD Mohammed Mhanna, MD, MPH Shareef Mansour, MD Kristine Yumul, MD Paulino Alvarez, MD Ernesto Ruiz Duque, MD |
| author_sort | Ibrahim Mortada, MD |
| collection | DOAJ |
| description | Background: The use of continuous flow left ventricular assist device (CF-LVAD) has revolutionized the management of advanced heart failure. One of the major complications associated with its use is the risk of bleeding, especially in the early postoperative period. Early events of postoperative bleeding have been associated with higher morbidity and mortality rates. Our study aims at identifying potential predictors of intraoperative bleeding, defined as 4 or more units of packed red blood cells transfused during surgery. A single-center retrospective cohort study of adult patients older than 18 years old who underwent CF-LVAD implantation between 2009 and 2024. Methods: Data were collected for the duration of implant hospitalization, including perioperative invasive hemodynamics, echocardiography, operative details, mechanical circulatory support, antiplatelets, inotropes, bleeding events, and blood product use, in addition to patient history and baseline characteristics. Results: A total of 208 patients were included in the analysis. Intraoperative bleeding occurred in 43 (20.67%) patients while 165 (79.33%) patients did not experience bleeding. Multilogistic regression analysis showed that artery bypass grafting pre-LVAD (odds ratio [OR] 2.98, confidence interval [CI] 1.2-7.42, p = 0.01) and temporary mechanical assist device pre-LVAD (OR 3.67, 95%CI 1.72-7.85, p < 0.001) were independent predictors of intraoperative bleeding during hospitalization. Intraoperative bleeding is also correlated with worse clinical outcomes, higher 90-day mortality (hazard ratio [HR] 10.4, p < 0.01, CI 95% 3.28-33.38) 206 subjects with 14 failures. Conclusion: History of coronary artery bypass grafting and mechanical circulatory support before the implantation of LVAD are independent predictors of intraoperative bleeding during hospitalization in these patients. Intraoperative bleeding is associated with higher frequency of right ventricle failure post-LVAD and higher 90-day mortality. |
| format | Article |
| id | doaj-art-abff8950e8504cc99ebf35a153fac690 |
| institution | Kabale University |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHLT Open |
| spelling | doaj-art-abff8950e8504cc99ebf35a153fac6902025-02-09T05:01:59ZengElsevierJHLT Open2950-13342025-02-017100195Prevalence, risk factors, and prognostic implications of intraoperative bleeding during CF-LVAD implantIbrahim Mortada, MD0Christos Kourek, MD, PhD1Rupesh Kshetri, MD2Arun Singhal, MD3Anthony Panos, MD4Alexandros Briasoulis, MD, PhD5Mohammed Mhanna, MD, MPH6Shareef Mansour, MD7Kristine Yumul, MD8Paulino Alvarez, MD9Ernesto Ruiz Duque, MD10Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, IowaMedical School of Athens, National and Kapodistrian University of Athens, Athens, GreeceDivision of Cardiology, Department of Medicine, University of Iowa, Iowa City, IowaDepartment of Cardiovascular Surgery, University of Iowa, Iowa City, IowaDepartment of Cardiovascular Surgery, University of Iowa, Iowa City, IowaMedical School of Athens, National and Kapodistrian University of Athens, Athens, GreeceDivision of Cardiology, Department of Medicine, University of Iowa, Iowa City, IowaDivision of Cardiology, Department of Medicine, University of Iowa, Iowa City, IowaDivision of Cardiology, Department of Medicine, University of Iowa, Iowa City, IowaDepartment of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OhioDivision of Cardiology, Department of Medicine, University of Iowa, Iowa City, Iowa; Corresponding author: Ernesto Ruiz Duque, MD, Division of Cardiology, Department of Medicine, University of Iowa, 200 Hawkins Dr, E 315GH, Iowa City, IA 52242.Background: The use of continuous flow left ventricular assist device (CF-LVAD) has revolutionized the management of advanced heart failure. One of the major complications associated with its use is the risk of bleeding, especially in the early postoperative period. Early events of postoperative bleeding have been associated with higher morbidity and mortality rates. Our study aims at identifying potential predictors of intraoperative bleeding, defined as 4 or more units of packed red blood cells transfused during surgery. A single-center retrospective cohort study of adult patients older than 18 years old who underwent CF-LVAD implantation between 2009 and 2024. Methods: Data were collected for the duration of implant hospitalization, including perioperative invasive hemodynamics, echocardiography, operative details, mechanical circulatory support, antiplatelets, inotropes, bleeding events, and blood product use, in addition to patient history and baseline characteristics. Results: A total of 208 patients were included in the analysis. Intraoperative bleeding occurred in 43 (20.67%) patients while 165 (79.33%) patients did not experience bleeding. Multilogistic regression analysis showed that artery bypass grafting pre-LVAD (odds ratio [OR] 2.98, confidence interval [CI] 1.2-7.42, p = 0.01) and temporary mechanical assist device pre-LVAD (OR 3.67, 95%CI 1.72-7.85, p < 0.001) were independent predictors of intraoperative bleeding during hospitalization. Intraoperative bleeding is also correlated with worse clinical outcomes, higher 90-day mortality (hazard ratio [HR] 10.4, p < 0.01, CI 95% 3.28-33.38) 206 subjects with 14 failures. Conclusion: History of coronary artery bypass grafting and mechanical circulatory support before the implantation of LVAD are independent predictors of intraoperative bleeding during hospitalization in these patients. Intraoperative bleeding is associated with higher frequency of right ventricle failure post-LVAD and higher 90-day mortality.http://www.sciencedirect.com/science/article/pii/S2950133424001447LVADheart failurebleedingmechanical circulatory supportsurvival |
| spellingShingle | Ibrahim Mortada, MD Christos Kourek, MD, PhD Rupesh Kshetri, MD Arun Singhal, MD Anthony Panos, MD Alexandros Briasoulis, MD, PhD Mohammed Mhanna, MD, MPH Shareef Mansour, MD Kristine Yumul, MD Paulino Alvarez, MD Ernesto Ruiz Duque, MD Prevalence, risk factors, and prognostic implications of intraoperative bleeding during CF-LVAD implant JHLT Open LVAD heart failure bleeding mechanical circulatory support survival |
| title | Prevalence, risk factors, and prognostic implications of intraoperative bleeding during CF-LVAD implant |
| title_full | Prevalence, risk factors, and prognostic implications of intraoperative bleeding during CF-LVAD implant |
| title_fullStr | Prevalence, risk factors, and prognostic implications of intraoperative bleeding during CF-LVAD implant |
| title_full_unstemmed | Prevalence, risk factors, and prognostic implications of intraoperative bleeding during CF-LVAD implant |
| title_short | Prevalence, risk factors, and prognostic implications of intraoperative bleeding during CF-LVAD implant |
| title_sort | prevalence risk factors and prognostic implications of intraoperative bleeding during cf lvad implant |
| topic | LVAD heart failure bleeding mechanical circulatory support survival |
| url | http://www.sciencedirect.com/science/article/pii/S2950133424001447 |
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