Document Detail


Determinants of outcomes for postcardiotomy VAD placement: an 11-year, two-institution study.
MedLine Citation:
PMID:  16684048     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Ventricular assist device (VAD) placement after postcardiotomy failure is associated with a high mortality. We sought to determine prognostic factors in order to help better select patients who may benefit from VAD placement. METHODS: From January 1992 to January 2003, 63 patients out of approximately 30,000 cardiac surgery patients (0.21%) developed postcardiotomy failure requiring VADs. Planned VAD for bridge to transplant or bridge to recovery were excluded. Multivariate logistic regression analysis, based on pre-VAD placement parameters, was used to determine prognostic factors for in-hospital 30-day mortality. RESULTS: Overall operative mortality was 73% (46 of 63). Multivariate logistic regression analysis identified median age </=50 (each additional year) (OR = 0.85, 95% CI = 0.77 to 0.95, p = 0.004) and median base deficit >/=0 mEq/L (each additional mEq/L) prior to VAD placement (OR = 0.60, 95% CI = 0.48 to 0.91, p = 0.012) to be independent predictors of improved 30-day survival. CONCLUSIONS: Postcardiotomy failure is a rare event but is associated with a very poor prognosis despite salvage therapies utilizing VADs. Age </=50 years and base deficit >/=0 (mEq/L) prior to VAD placement are associated with improved 30-day survival.
Authors:
Subroto Paul; Marzia Leacche; Daniel Unic; Gregory S Couper; Thomas E Macgillivray; Arvind K Agnihotri; Lawrence H Cohn; John G Byrne
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study    
Journal Detail:
Title:  Journal of cardiac surgery     Volume:  21     ISSN:  0886-0440     ISO Abbreviation:  J Card Surg     Publication Date:    2006 May-Jun
Date Detail:
Created Date:  2006-05-10     Completed Date:  2006-10-24     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8908809     Medline TA:  J Card Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  234-7     Citation Subset:  IM    
Affiliation:
The Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Cardiac Surgical Procedures / adverse effects*
Female
Follow-Up Studies
Heart-Assist Devices*
Humans
Male
Middle Aged
Postoperative Complications
Prognosis
Retrospective Studies
Shock, Cardiogenic / etiology,  mortality,  surgery*
Survival Rate
Treatment Failure
Comments/Corrections
Comment In:
J Card Surg. 2006 May-Jun;21(3):238-9   [PMID:  16684049 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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