Association of timing of percutaneous left ventricular assist device insertion with outcomes in patients undergoing cardiac surgery.

ABSTRACT

Objectives: The aim of this study was to explore the associations between percutaneous ventricular assist device (pVAD) insertion timing relative to cardiac surgery and patient outcomes. Methods: The Nationwide Inpatient Sample was queried for patients undergoing cardiac surgery and pVAD insertion in the same admission from 2016 to 2019. Patients were stratified by timing of pVAD insertion. Preoperative characteristics, postoperative complications, and mortality were compared among groups. Results: Overall, 3695 patients underwent cardiac surgery and pVAD insertion during the same hospitalization (pre 1130, intra 1690, and post 875). The distribution of cardiac surgery procedures was similar across groups. Median Elixhauser Comorbidity Index was 13 for pre-, 15 for intra-, and 17 for postoperative pVAD patients (P = .021). Patients who received a postoperative pVAD were associated with increased mortality (pre 18%, intra 39%, and post 54%; P < .01). Increased complication rates were also associated with postoperative pVAD insertion (pre 61%, intra 55%, and post 75%; P < .01). Preoperative pVAD insertion was associated with increase rates of sepsis (pre 18%, intra 9.8%, and post 17%; P = .01) and pneumonia (pre 38%, intra 23%, and post 31%; P < .01). Postoperative pVAD insertion was associated with increased rates of gastrointestinal bleeding (pre 2.2%, intra 3.0%, and post 7.4%; P = .01), renal failure (pre 10%, intra 9.2%, and post 17%; P = .01), and prolonged ventilation (pre 44%, intra 41%, and post 54%; P = .02). Conclusions: Postoperative pVAD insertion following cardiac surgery was associated with increased complications and mortality compared with preoperative or intraoperative insertion. Further studies should explore optimal utilization and timing of pVAD insertion in patients undergoing cardiac surgery.