A multi-institutional outcome analysis of patients undergoing left ventricular assist device implantation stratified by sex and race

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• 作者：Justin van Meeteren ; DO^a ; Simon Maltais ; MD ; PhD^a ; Shannon M. Dunlay ; MS ; MD^a ; Nicholas A. Haglund ; MD^b ; Mary Beth Davis ; MS ; CCRP^b ; Jennifer Cowger ; MS ; MD^c ; Palak Shah ; MS ; MD^d ; Keith D. Aaronson ; MS ; MD^e ; Francis D. Pagani ; MD ; PhD^e ; John M. Stulak ; MD^a ; ^{stulak.john@mayo.edu}
• 关键词：disparities ; race ; ventricular assist device ; mechanical circulatory assistance ; ventricular assist device
• 刊名：The Journal of Heart and Lung Transplantation
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：36
• 期：1
• 页码：64-70
• 全文大小：807 K
• 卷排序：36

文摘

Earlier studies have demonstrated disparities in patients undergoing left ventricular assist device (LVAD) implantation when stratified according to sex and race. Because very few data exist from large investigations, we reviewed data from the registry of the Mechanical Circulatory Support Research Network.MethodsBetween May 2004 and September 2014, 734 patients underwent primary LVAD implantation at our institutions. Median age at implant was 57 (range 18 to 82) years and there were 577 males (80%). Race included Caucasian (C) in 586 patients (82%), African-American (AA) in 112 (16%), and other (O) in 21 (3%). Between sexes, significant pre-operative differences most commonly included median age at implant (males 60 years, females 57 years), ischemic etiology (53% vs 35%) and mean INTERMACS profile (2.9 vs 2.5). Between races, significant pre-operative differences most commonly included median age at implant (C = 61 vs AA = 51 vs O = 51), New York Heart Association functional class (85% vs 100% vs 92%) and ischemic etiology (55% vs 24% vs 40%).ResultsThere were no significant differences in survival at 1, 3 or 5 years by sex or race. Similarly, there were no differences in time-related freedom from stroke, drive-line infection, gastrointestinal bleeding or pump thrombus by sex or race. After controlling for differences, neither sex nor race was associated with survival (p = 0.09 and p = 0.18, respectively), stroke (p = 0.28 and p = 0.21), drive-line infection (p = 0.9 and p = 0.92), gastrointestinal bleed (p = 0.48 and p = 0.45) or pump thrombus (p = 0.99 and p = 0.8).ConclusionsIn this large, multi-institutional analysis, although some pre-operative clinical characteristics varied, they did not translate into any significant differences in late survival or complications while on LVAD support.