Determinants of Outcomes for Postcardiotomy VAD Placement: An 11-Year, Two-Institution Study

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Abstract

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.

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