Analysis Of Clinical, Biochemical And Echocardiographic Criteria For Heart Failure With Preserved Ejection Fraction
HFSA ePoster Library. Stringer B. 09/10/21; 343512; 275
Bryan Stringer
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Abstract
Discussion Forum (0)
Introduction: Temporary mechanical circulatory support (TMCS) bridging strategies are increasingly used for acute decompensated heart failure-related cardiogenic shock (ADHF-CS). However, the impact of bridging approach on post-operative outcomes in ADHF-CS patients who receive a durable left ventricular assist device (LVAD) or heart transplant (HT) is unknown.
Methods: Durable LVAD or HT recipients from July 1, 2014 to December 31, 2019 with pre-operative ADHF-CS were identified in the Society of Thoracic Surgeons Adult Cardiac Surgery Database and stratified by pre-operative TMCS strategy. Associations between TMCS strategies and post-operative outcomes were evaluated using propensity-score matching and adjustment for pre-selected covariates (pre-operative hemoglobin, platelets, albumin, bilirubin, international normalized ratio, creatinine, cardiopulmonary resuscitation, and operative status).
Results: A total of 8,777 ADHF-CS patients were bridged to LVAD (5,975; 68%) or HT (2,802; 32%). The composite of operative/30-day death following LVAD or HT was highest in patients managed with VA ECMO (22%) and lowest in those managed without TMCS (7%), with a stepwise gradient of incidence by level of hemodynamic support (Figure, top). Other post-operative outcomes including major bleeding, cerebrovascular accident, cardiac arrest, prolonged mechanical ventilation, renal failure, and sepsis/pneumonia followed a similar pattern. However, after propensity score matching and adjustment, there were no differences in the odds of operative/30-day death or major bleeding with IABP versus no TMCS (Figure, bottom). While there was no difference in operative/30-day death, odds of major bleeding were lower with catheter-based MCS compared with IABP (OR 0.70, 95% CI 0.53 - 0.92).
Conclusion: ADHF-CS patients experience high rates of cardiac and non-cardiac adverse events post- LVAD and HT. A crude relationship between TMCS bridging strategy and post-operative outcomes was observed. However, after adjustment, pre-operative TMCS bridging strategy did not independently confer risk of near-term post-operative mortality among ADHF-CS patients who underwent HT or durable LVAD implantation.
Methods: Durable LVAD or HT recipients from July 1, 2014 to December 31, 2019 with pre-operative ADHF-CS were identified in the Society of Thoracic Surgeons Adult Cardiac Surgery Database and stratified by pre-operative TMCS strategy. Associations between TMCS strategies and post-operative outcomes were evaluated using propensity-score matching and adjustment for pre-selected covariates (pre-operative hemoglobin, platelets, albumin, bilirubin, international normalized ratio, creatinine, cardiopulmonary resuscitation, and operative status).
Results: A total of 8,777 ADHF-CS patients were bridged to LVAD (5,975; 68%) or HT (2,802; 32%). The composite of operative/30-day death following LVAD or HT was highest in patients managed with VA ECMO (22%) and lowest in those managed without TMCS (7%), with a stepwise gradient of incidence by level of hemodynamic support (Figure, top). Other post-operative outcomes including major bleeding, cerebrovascular accident, cardiac arrest, prolonged mechanical ventilation, renal failure, and sepsis/pneumonia followed a similar pattern. However, after propensity score matching and adjustment, there were no differences in the odds of operative/30-day death or major bleeding with IABP versus no TMCS (Figure, bottom). While there was no difference in operative/30-day death, odds of major bleeding were lower with catheter-based MCS compared with IABP (OR 0.70, 95% CI 0.53 - 0.92).
Conclusion: ADHF-CS patients experience high rates of cardiac and non-cardiac adverse events post- LVAD and HT. A crude relationship between TMCS bridging strategy and post-operative outcomes was observed. However, after adjustment, pre-operative TMCS bridging strategy did not independently confer risk of near-term post-operative mortality among ADHF-CS patients who underwent HT or durable LVAD implantation.
Introduction: Temporary mechanical circulatory support (TMCS) bridging strategies are increasingly used for acute decompensated heart failure-related cardiogenic shock (ADHF-CS). However, the impact of bridging approach on post-operative outcomes in ADHF-CS patients who receive a durable left ventricular assist device (LVAD) or heart transplant (HT) is unknown.
Methods: Durable LVAD or HT recipients from July 1, 2014 to December 31, 2019 with pre-operative ADHF-CS were identified in the Society of Thoracic Surgeons Adult Cardiac Surgery Database and stratified by pre-operative TMCS strategy. Associations between TMCS strategies and post-operative outcomes were evaluated using propensity-score matching and adjustment for pre-selected covariates (pre-operative hemoglobin, platelets, albumin, bilirubin, international normalized ratio, creatinine, cardiopulmonary resuscitation, and operative status).
Results: A total of 8,777 ADHF-CS patients were bridged to LVAD (5,975; 68%) or HT (2,802; 32%). The composite of operative/30-day death following LVAD or HT was highest in patients managed with VA ECMO (22%) and lowest in those managed without TMCS (7%), with a stepwise gradient of incidence by level of hemodynamic support (Figure, top). Other post-operative outcomes including major bleeding, cerebrovascular accident, cardiac arrest, prolonged mechanical ventilation, renal failure, and sepsis/pneumonia followed a similar pattern. However, after propensity score matching and adjustment, there were no differences in the odds of operative/30-day death or major bleeding with IABP versus no TMCS (Figure, bottom). While there was no difference in operative/30-day death, odds of major bleeding were lower with catheter-based MCS compared with IABP (OR 0.70, 95% CI 0.53 - 0.92).
Conclusion: ADHF-CS patients experience high rates of cardiac and non-cardiac adverse events post- LVAD and HT. A crude relationship between TMCS bridging strategy and post-operative outcomes was observed. However, after adjustment, pre-operative TMCS bridging strategy did not independently confer risk of near-term post-operative mortality among ADHF-CS patients who underwent HT or durable LVAD implantation.
Methods: Durable LVAD or HT recipients from July 1, 2014 to December 31, 2019 with pre-operative ADHF-CS were identified in the Society of Thoracic Surgeons Adult Cardiac Surgery Database and stratified by pre-operative TMCS strategy. Associations between TMCS strategies and post-operative outcomes were evaluated using propensity-score matching and adjustment for pre-selected covariates (pre-operative hemoglobin, platelets, albumin, bilirubin, international normalized ratio, creatinine, cardiopulmonary resuscitation, and operative status).
Results: A total of 8,777 ADHF-CS patients were bridged to LVAD (5,975; 68%) or HT (2,802; 32%). The composite of operative/30-day death following LVAD or HT was highest in patients managed with VA ECMO (22%) and lowest in those managed without TMCS (7%), with a stepwise gradient of incidence by level of hemodynamic support (Figure, top). Other post-operative outcomes including major bleeding, cerebrovascular accident, cardiac arrest, prolonged mechanical ventilation, renal failure, and sepsis/pneumonia followed a similar pattern. However, after propensity score matching and adjustment, there were no differences in the odds of operative/30-day death or major bleeding with IABP versus no TMCS (Figure, bottom). While there was no difference in operative/30-day death, odds of major bleeding were lower with catheter-based MCS compared with IABP (OR 0.70, 95% CI 0.53 - 0.92).
Conclusion: ADHF-CS patients experience high rates of cardiac and non-cardiac adverse events post- LVAD and HT. A crude relationship between TMCS bridging strategy and post-operative outcomes was observed. However, after adjustment, pre-operative TMCS bridging strategy did not independently confer risk of near-term post-operative mortality among ADHF-CS patients who underwent HT or durable LVAD implantation.
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