Early Bleeding is Associated with Increased Length of Stay and Early Death in LVAD Recipients

PURPOSE: We sought to examine the effects of early (non-GI) bleeding (EB) on length of stay and early mortality (3-months) in patients receiving the HeartwareTM HVADTM system for destination therapy. METHODS: HVAD patients enrolled in the ENDURANCE and ENDURANCE Supplemental trials (n=604) were eligible. Patients were separated into two groups: those with postoperative bleeding by Intermacs definition, excluding GI bleeding, within 72 hours of implant and those without any bleeding within 72 hours. Length of stay, adverse events and survival were examined out to 3 months. RESULTS: Comparison of baseline characteristics shows that EBs were older (66.6 vs 63.1 years, p=0.002), had smaller BMI (26.2 vs 28.0 kg/m2) p=0.0012), higher BUN (12.2 vs 10.0 mmol/L, p=0.0004), higher total bilirubin (20.9 vs 17.9 umol/L, p=0.05), and more redo sternotomies (48.3% vs 30.9%, p=0.0013). Intraoperatively, EBs had significantly longer CPB time (115 vs 85.9 min, p<0.0001), more PRBC (4.7 vs 2.4 units, p<0.0001), more FFP (5.2 vs 2.9 units, p<0.0001), more platelets (5.9 vs 3.3 packs, p=0.05) (Table 1). Length of stay for EBs was significantly longer (34.5 vs 23.4 days, p=0.0057) and 3-month survival significantly less (75.3% vs 91.4%, p<0.001) (Figure 1). CONCLUSION: LVAD patients who experienced EB had more redo sternotomy, longer CPB times, more OR transfusions, longer length of stay and decreased short-term survival compared to those who did not have EB. Prospective study is warranted.

Duke Scholars

Author Carmelo Alessio Milano Surgery, Cardiovascular and Thoracic Surgery