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Associated factors and clinical outcomes in mechanical circulatory support use in patients undergoing high risk on-pump cardiac surgery: Insights from the LEVO-CTS trial.

Publication ,  Journal Article
Verma, S; Rathwell, S; Fremes, S; Zheng, Y; Mehta, R; Lopes, RD; Alexander, JH; Goodman, SG; Diepen, SV; LEVO-CTS investigators,
Published in: Am Heart J
June 2022

BACKGROUND: We describe variables and outcomes associated with peri-operative mechanical circulatory support (MCS) utilization among patients enrolled in the Levosimendan in patients with Left Ventricular Systolic Dysfunction Undergoing Cardiac Surgery Requiring Cardiopulmonary Bypass (LEVO-CTS) trial. METHODS: In the LEVO-CTS trial, MCS utilization (defined as intra-aortic balloon pump, extracorporeal membrane oxygenation, or surgical ventricular assist device) within 5 days of surgery was examined. The association between MCS use and outcomes including 90-day mortality, 30-day renal-replacement therapy, and hospital and critical stay length of stay were determined. RESULTS: Among the 849 patients from 70 centers randomized to levosimendan or placebo, 85 (10.0%) patients were treated with MCS (71 intra-aortic balloon pump, 7 extracorporeal membrane oxygenation, 7 ventricular assist device); with 89.4% started on post-operative day 0. Inter-institutional use ranged from 0% to 100%. Variables independently associated with MCS utilization included combined coronary artery bypass grafting and valve surgery (adjusted odds ratio [OR] 2.73, 95% confidence interval [CI] 1.70-4.37, P < .001), history of lung disease (OR 1.70, 95% CI 1.06-2.70, P = .029), and history of heart failure (OR 2.44, 95% CI 1.10-5.45, P = .027). Adjusted 90-day mortality (22.4% vs 4.1%, hazard ratio 6.11, 95% CI 3.95-9.44, P < .001) was higher, and median critical care length of stay (8.0 vs 4.0 days, P < .001) was longer in patients managed with MCS. CONCLUSIONS: In a randomized controlled trial of high-risk cardiac surgical patients in North America, we observed patient, and surgical variables associated with MCS utilization. MCS use was associated with a higher risk of post-operative mortality.

Duke Scholars

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

June 2022

Volume

248

Start / End Page

35 / 41

Location

United States

Related Subject Headings

  • Simendan
  • Risk Factors
  • Intra-Aortic Balloon Pumping
  • Humans
  • Heart-Assist Devices
  • Extracorporeal Membrane Oxygenation
  • Cardiovascular System & Hematology
  • Cardiac Surgical Procedures
  • 3201 Cardiovascular medicine and haematology
  • 1117 Public Health and Health Services
 

Citation

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Verma, S., Rathwell, S., Fremes, S., Zheng, Y., Mehta, R., Lopes, R. D., … LEVO-CTS investigators, . (2022). Associated factors and clinical outcomes in mechanical circulatory support use in patients undergoing high risk on-pump cardiac surgery: Insights from the LEVO-CTS trial. Am Heart J, 248, 35–41. https://doi.org/10.1016/j.ahj.2022.02.013
Verma, Sanam, Sarah Rathwell, Stephen Fremes, Yinggan Zheng, Rajendra Mehta, Renato D. Lopes, John H. Alexander, Shaun G. Goodman, Sean van Diepen, and Sean van LEVO-CTS investigators. “Associated factors and clinical outcomes in mechanical circulatory support use in patients undergoing high risk on-pump cardiac surgery: Insights from the LEVO-CTS trial.Am Heart J 248 (June 2022): 35–41. https://doi.org/10.1016/j.ahj.2022.02.013.
Verma S, Rathwell S, Fremes S, Zheng Y, Mehta R, Lopes RD, Alexander JH, Goodman SG, Diepen SV, LEVO-CTS investigators. Associated factors and clinical outcomes in mechanical circulatory support use in patients undergoing high risk on-pump cardiac surgery: Insights from the LEVO-CTS trial. Am Heart J. 2022 Jun;248:35–41.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

June 2022

Volume

248

Start / End Page

35 / 41

Location

United States

Related Subject Headings

  • Simendan
  • Risk Factors
  • Intra-Aortic Balloon Pumping
  • Humans
  • Heart-Assist Devices
  • Extracorporeal Membrane Oxygenation
  • Cardiovascular System & Hematology
  • Cardiac Surgical Procedures
  • 3201 Cardiovascular medicine and haematology
  • 1117 Public Health and Health Services