TY - JOUR
T1 - Incidence, factors, and prognostic impact of re-exploration for bleeding after continuous-flow left ventricular assist device implantation - A Japanese single-center study
AU - Iwasaki, Keiichiro
AU - Yoshitake, Koichi
AU - Yagi, Nobuichiro
AU - Sujino, Yasumori
AU - Anegawa, Eiji
AU - Mochizuki, Hiroki
AU - Kuroda, Kensuke
AU - Nakajima, Seiko
AU - Watanabe, Takuya
AU - Seguchi, Osamu
AU - Yanase, Masanobu
AU - Fukushima, Satsuki
AU - Fujita, Tomoyuki
AU - Kobayashi, Junjiro
AU - Ito, Hiroshi
AU - Fukushima, Norihide
N1 - Funding Information:
We thanked for both centers; NCVC and Okayama University. This work was supported by Japan Society for the Promotion of Science KAKENHI (Grant No. 19K17580). We thank Editage (www.editage.com) for English language editing.
Funding Information:
We thanked for both centers; NCVC and Okayama University. This work was supported by Japan Society for the Promotion of Science KAKENHI (Grant No. 19K17580). We thank Editage (www. editage.com) for English language editing.
Publisher Copyright:
© 2020 Japanese Circulation Society. All rights reserved.
PY - 2020/10/23
Y1 - 2020/10/23
N2 - Background: Continuous-flow left ventricular assist device (CF-LVAD) substantially improves survival in endstage heart failure patients. However, bleeding complications are common after CF-LVAD implantation and in some cases, re-exploration for bleeding is needed. We aimed to investigate the incidence, timing, and risk factors of bleeding requiring re-exploration after CF-LVAD implantation. Methods and Results: We retrospectively reviewed 162 consecutive patients (age 43±13 years, 71% men) who underwent CF-LVAD implantation (HeartMateII 119, Jarvik2000 15, HVAD 13, EVAHEART 10, DuraHeart 5) from January 2012 to June 2019. During follow-up [median 662 days, interquartile range (IQR) 364–1,116 days], 35 (21.6%) experienced re-exploration for bleeding. The median timing of re-exploration was 6 (IQR 1–10) days. In the multivariate logistic regression analysis, postoperative platelet count was an independent predictor for re-exploration for bleeding after CF-LVAD implantation (per 104/μL: odds ratio 0.83, 95% confidence interval 0.74–0.93, P=0.002). Patients who experienced re-exploration for bleeding had a significantly worse survival rate than patients who did not (at 4 years, 73.6% vs. 90.1%, P=0.039). Conclusions: Re-exploration for bleeding is prevalent after CF-LVAD implantation, especially in patients with low postoperative platelet counts. As bleeding requiring re-exploration is associated with poor prognosis, risk stratification using the postoperative platelet count may be beneficial for these patients.
AB - Background: Continuous-flow left ventricular assist device (CF-LVAD) substantially improves survival in endstage heart failure patients. However, bleeding complications are common after CF-LVAD implantation and in some cases, re-exploration for bleeding is needed. We aimed to investigate the incidence, timing, and risk factors of bleeding requiring re-exploration after CF-LVAD implantation. Methods and Results: We retrospectively reviewed 162 consecutive patients (age 43±13 years, 71% men) who underwent CF-LVAD implantation (HeartMateII 119, Jarvik2000 15, HVAD 13, EVAHEART 10, DuraHeart 5) from January 2012 to June 2019. During follow-up [median 662 days, interquartile range (IQR) 364–1,116 days], 35 (21.6%) experienced re-exploration for bleeding. The median timing of re-exploration was 6 (IQR 1–10) days. In the multivariate logistic regression analysis, postoperative platelet count was an independent predictor for re-exploration for bleeding after CF-LVAD implantation (per 104/μL: odds ratio 0.83, 95% confidence interval 0.74–0.93, P=0.002). Patients who experienced re-exploration for bleeding had a significantly worse survival rate than patients who did not (at 4 years, 73.6% vs. 90.1%, P=0.039). Conclusions: Re-exploration for bleeding is prevalent after CF-LVAD implantation, especially in patients with low postoperative platelet counts. As bleeding requiring re-exploration is associated with poor prognosis, risk stratification using the postoperative platelet count may be beneficial for these patients.
KW - Bleeding
KW - Continuous-flow left ventricular assist device implantation
KW - Prognostic impact
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U2 - 10.1253/circj.CJ-20-0238
DO - 10.1253/circj.CJ-20-0238
M3 - Article
C2 - 32999142
AN - SCOPUS:85093845544
VL - 84
SP - 1949
EP - 1956
JO - Circulation Journal
JF - Circulation Journal
SN - 1346-9843
IS - 11
ER -