Duration of inotropic support after left ventricular assist device implantation: Risk factors and impact on outcome Soren Schenk, MD, Patrick M. McCarthy,

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Presentation transcript:

Duration of inotropic support after left ventricular assist device implantation: Risk factors and impact on outcome Soren Schenk, MD, Patrick M. McCarthy, MD, Eugene H. Blackstone, MD, Jingyuan Feng, MS, Randall C. Starling, MD, MPH, Jose L. Navia, MD, Lingmei Zhou, MS, Katherine J. Hoercher, RN, Nicholas G. Smedira, MD, Kiyotaka Fukamachi, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 131, Issue 2, Pages 447-454 (February 2006) DOI: 10.1016/j.jtcvs.2005.09.031 Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Duration of inotropic support after left ventricular assist device (LVAD) implantation. Circles represent percentages of patients on inotropic support at the time after implantation (noted on horizontal axis), vertical bars are asymmetric 68% confidence intervals for these estimates (equivalent to ±1 standard error), and numbers in parentheses are patients still on inotropes who have not died, undergone transplantation, or had their device removed after recovery. The solid line, enclosed within dashed 68% confidence limits, is a parametric estimate; from this is derived the incidence of ending inotropic support (hazard function) shown in the inset. The Journal of Thoracic and Cardiovascular Surgery 2006 131, 447-454DOI: (10.1016/j.jtcvs.2005.09.031) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Relation between duration of inotropic support and preinsertion right ventricular stroke work index (RVSWI). A, Three-dimensional nomogram. Notice that at high preoperative RVSWI values, most patients are not on inotropic support beyond 7 days, but at low RVSWI values, patients are more likely to be on support for a prolonged period. B, Simple and unadjusted stratification of patients according to RVSWI. Format is as for Figure 1. C, Nomogram as in panel A but solved for prevalence of inotropic support for at least 14 postoperative (PO) days according to RVSWI level. The Journal of Thoracic and Cardiovascular Surgery 2006 131, 447-454DOI: (10.1016/j.jtcvs.2005.09.031) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Impact of inotropic support on survival during left ventricular assist device (LVAD) support. A, Hazard functions (instantaneous risk of death) for 2 simulated patients. Patient A was weaned off inotropic support 4 days after LVAD implantation. Hazard decreased nearly 10-fold. Patient B was weaned off inotropic support 21 days after LVAD implantation. Hazard decreased but not as much as for patient A. B, Survival effect of short (simulated patient A) versus prolonged (simulated patient B) inotropic support derived from the hazard functions. Compared with patient A, survival of patient B is reduced both by longer exposure to the same high hazard during inotropic support and by higher hazard after discontinuing inotropic support commensurate with its longer duration. The Journal of Thoracic and Cardiovascular Surgery 2006 131, 447-454DOI: (10.1016/j.jtcvs.2005.09.031) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Simulated 6-month survival according to duration of inotropic support expressed on vertical axis as percentage of patients surviving to transplantation. See the “Patients and Methods” section, equation (1), for details of calculation. The Journal of Thoracic and Cardiovascular Surgery 2006 131, 447-454DOI: (10.1016/j.jtcvs.2005.09.031) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Survival after implantation of a right ventricular assist device (RVAD). Format is as in Figure 1. The Journal of Thoracic and Cardiovascular Surgery 2006 131, 447-454DOI: (10.1016/j.jtcvs.2005.09.031) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions