The impact of peripheral arterial disease on patients with mechanical circulatory support. (June 2020)

• Record Type: Journal Article
• Authors: Ullah, Waqas; Sattar, Yasar; Darmoch, Fahed; Al-khadra, Yasser; Mir, Tanveer; Ajmal, Rasikh; Moussa-Pacha, Homam; Glazier, James; Asfour, Abedelrahim; Gardi, Delair; Alraies, M. Chadi
• Is Part Of: IJC heart & vasculature. Volume 28(2020)
• Publication Date: 2020-06
• Subjects: Left ventricular assist device -- Peripheral arterial disease -- End-stage heart failure; BiVAD biventricular assist device -- CAD coronary artery disease -- CABG coronary artery bypass surgery -- CKD chronic kidney disease -- LOS length of stay -- LVAD left ventricular assist device -- OMT optimal medical therapy -- MCS mechanical circulatory support -- NIS National Inpatient Sample -- PAD peripheral arterial disease -- PCI percutaneous coronary intervention; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular system -- Pathophysiology -- Periodicals; 616.1005
• DOI: 10.1016/j.ijcha.2020.100509
• Languages: English
• ISSNs: 2352-9067

Abstract

Highlights: Patient having LVAD and history of PAD have a higher odd to develop acute myocardial infarction as compared to non-PAD. Major bleeding requiring transfusion, and thromboembolic complications were higher in patients with PAD disease. The LVAD placement in prior PAD can have high odds of surgical wound infections, and implant-related complications as compared to non-PAD. The odds of developing acute renal failure are high in LVAD with PAD as compared to non-PAD group. LVAD placement in history of PAD can have high in-hospital mortality are high as compared to non-PAD group. Abstract: Background: Left ventricular assist devices (LVAD) are indicated as bridging or destination therapy for patients with advanced (Stage D) heart failure and reduced ejection fraction (HFrEF). Due to the clustering of the mutual risk factors, HFrEF patients have a high prevalence of peripheral arterial disease (PAD). This, along with the fact that continuous flow LVAD influence shear stress on the vasculature, can further deteriorate the PAD. Methods: We queried the National Inpatient Sample (NIS) database (2002–2014) to identify the burden of pre-existing PAD cases, its association with LVAD, in-hospital mortality, and other complications of LVAD. The adjusted odds ratio (aOR) and 95% confidence interval (CI) were calculated using the Cochran–Mantel–Haenszel test. Results: A total of 20, 817 LVAD patients, comprising of 1, 625 (7.8%) PAD and 19, 192 (91.2%) non-PAD patients were included in the study. The odds of in-hospital mortality in PAD patients were significantly higher compared to non-PAD group (OR 1.29, CI, 1.07–1.55, P = 0.007). The PAD group had significantly higher adjusted odds as compared to non-PAD group for acute myocardial infarction (aOR 1.29; 95% CI, 1.07–1.55, P = 0.007), major bleeding requiring transfusion (aOR, 1.286; 95% CI, 1.136–1.456, P < 0.001), vascular complications (aOR, 2.360; 95% CI, 1.781–3.126, P < 0.001), surgical wound infections (aOR, 1.50; 95% CI, 1.17–1.94, P = 0.002), thromboembolic complications (aOR, 1.69; 95% CI, 1.36–2.10, P < 0.001), implant-related complications (aOR, 1.47; 95% CI, 1.19–1.80, P < 0.001), and acute renal failure (aOR, 1.26; 95% CI, 1.12–1.43, P < 0.001). Conclusion: PAD patients can have high LVAD associated mortality as compared to non-PAD.