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American Heart Journal

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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 - 28/04/22

Doi : 10.1016/j.ahj.2022.02.013 
Sanam Verma, MD a, Sarah Rathwell, MSc b, Stephen Fremes, MD, MSc c, Yinggan Zheng, MA, MEd b, Rajendra Mehta, MD, MS d, Renato D. Lopes, MD, MHS, PhD d, John H. Alexander, MD, MHS d, Shaun G. Goodman, MD, MSc b, e, Sean van Diepen, MD, MSc a, b, f, ⁎
On behalf of the

LEVO-CTS investigators

a Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada 
b Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada 
c Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada 
d Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 
e Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada 
f Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada 

⁎Reprint requests: Sean van Diepen, MD, MSc, 2C2 Cardiology Walter MacKenzie Center, University of Alberta Hospital, 8440-11 St., Edmonton, Alberta T6G 2B7, Canada.2C2 Cardiology Walter MacKenzie CenterUniversity of Alberta Hospital8440-11 StEdmontonAlbertaT6G 2B7Canada

Riassunto

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.

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☆ This paper was handled by Guest Editor (Nathaniel Rosso Smilowitz, MD, MS).
 Clinical Trial Registration: ClinicalTrials.gov number, NCT02025621


© 2022  Elsevier Inc. Tutti i diritti riservati.
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Vol 248

P. 35-41 - Giugno 2022 Ritorno al numero
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