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Impact of preoperative liver dysfunction on outcomes in patients with left ventricular assist devices.
Yalcin, Yunus C; Muslem, Rahatullah; Veen, Kevin M; Soliman, Osama I; Manintveld, Olivier C; Darwish Murad, Sarwa; Kilic, Ahmet; Constantinescu, Alina A; Brugts, Jasper J; Alkhunaizi, Fatimah; Birim, Ozcan; Tedford, Ryan J; Bogers, Ad J J C; Hsu, Steven; Caliskan, Kadir.
Afiliação
  • Yalcin YC; Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands.
  • Muslem R; Department of Cardio-thoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands.
  • Veen KM; Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands.
  • Soliman OI; Department of Cardio-thoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands.
  • Manintveld OC; Department of Cardio-thoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands.
  • Darwish Murad S; Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands.
  • Kilic A; Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands.
  • Constantinescu AA; Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands.
  • Brugts JJ; Department of Cardiology, Johns Hopkins Heart and Vascular Institute, Baltimore, MD, USA.
  • Alkhunaizi F; Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands.
  • Birim O; Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands.
  • Tedford RJ; Department of Cardiology, Johns Hopkins Heart and Vascular Institute, Baltimore, MD, USA.
  • Bogers AJJC; Department of Cardio-thoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands.
  • Hsu S; Department of Cardiology, Medical University of South Carolina, Charleston, SC, USA.
  • Caliskan K; Department of Cardio-thoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands.
Eur J Cardiothorac Surg ; 57(5): 920-928, 2020 05 01.
Article em En | MEDLINE | ID: mdl-31828334
ABSTRACT

OBJECTIVES:

We evaluated the impact of preoperative liver function on early and 1-year postoperative outcomes in patients supported with a left ventricular assist device (LVAD) and subsequent evolution of liver function markers.

METHODS:

A retrospective multicentre cohort study was conducted, including all patients undergoing continuous-flow LVAD implantation. The Model for End-stage Liver Disease (MELD) score was used to define liver dysfunction.

RESULTS:

Overall, 290 patients with an LVAD [78% HeartMate II, 15% HVAD and 7% HeartMate 3, mean age 55 (18), 76% men] were included. Over 40 000 measurements of liver function markers were collected over a 1-year period. A receiver operating characteristic curve analysis for the 1-year mortality rate identified the optimal cut-off value of 12.6 for the MELD score. Therefore, the cohort was dichotomized into patients with an MELD score of less than or greater than 12.6. The early (90-day) survival rates in patients with and without liver dysfunction were 76% and 91% (P = 0.002) and 65% and 90% at 1 year, respectively (P < 0.001). Furthermore, patients with preoperative liver dysfunction had more embolic events and more re-explorations. At the 1-year follow-up, liver function markers showed an overall improvement in the majority of patients, with or without pre-LVAD liver dysfunction.

CONCLUSIONS:

Preoperative liver dysfunction is associated with higher early 90-day and 1-year mortality rates after LVAD implantation. Furthermore, liver function improved in both patient groups. It has become imperative to optimize the selection criteria for possible LVAD candidates, since those who survive the first year show excellent recovery of their liver markers.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Coração Auxiliar / Doença Hepática Terminal / Insuficiência Cardíaca / Hepatopatias Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Coração Auxiliar / Doença Hepática Terminal / Insuficiência Cardíaca / Hepatopatias Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2020 Tipo de documento: Article