Incidence, Factors, and Prognostic Impact of Re-Exploration for Bleeding After Continuous-Flow Left Ventricular Assist Device Implantation　- A Japanese Single-Center Study.

Abstract

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.

• Authors: Keiichiro Iwasaki, Koichi Yoshitake, Nobuichiro Yagi, Yasumori Sujino, Eiji Anegawa, Hiroki Mochizuki, Kensuke Kuroda, Seiko Nakajima, Takuya Watanabe, Osamu Seguchi, Masanobu Yanase, Satsuki Fukushima, Tomoyuki Fujita, Junjiro Kobayashi, Hiroshi Ito, Norihide Fukushima
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 84 Issue 11 Pg. 1949-1956 (10 23 2020) ISSN: 1347-4820 [Electronic] Japan
• PMID: 32999142 (Publication Type: Journal Article)

Topics

• Adult
• Female
• Heart Failure (surgery)
• Heart-Assist Devices (adverse effects)
• Hemorrhage (epidemiology, etiology)
• Humans
• Incidence
• Japan (epidemiology)
• Male
• Middle Aged
• Prognosis
• Retrospective Studies