Preoperative atrial fibrillation increases risk of thromboembolic events after left ventricular assist device implantation

John M. Stulak, Salil Deo, John Schirger, Keith D. Aaronson, Soon J. Park, Lyle D. Joyce, Richard C. Daly, Francis D. Pagani

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Background Because no series has specifically analyzed the impact of preoperative atrial fibrillation (AF) on patients already at higher risk of thromboembolism after implantation of a left ventricular assist device (LVAD), we review our experience with these patients. Methods Between July 2003 and September 2011, 389 patients (308 male) underwent implantation of a continuous flow LVAD at University of Michigan Hospital and Mayo Clinic. Median age at implant was 60 years (range, 18 to 79 years). Preoperative AF was present in 120 patients (31%). Outcomes were analyzed for the association of preoperative AF and postoperative thromboembolic (TE) events defined as stroke, transient ischemic attack, hemolysis, or pump thrombosis. Thromboembolic events occurring within the first 30 days were not counted. Results One hundred thirty-eight TEs events occurred in 97/389 patients (25%) for an event rate of 0.31 TE events/patient-years of support. Freedom from a TE event in patients with preoperative AF was 62% at 1 year and 46% at 2 years compared with 79% and 72% at 1 and 2 years, respectively, in patients without preoperative AF (p < 0.001). Median survival was 10 months (maximum 7.2 years, total 439 patient-years). Preoperative AF did not decrease late survival at 1 and 2 years after LVAD implant (preop AF: 85% and 70% versus no preop AF: 82% and 70%, respectively; p = 0.55). Conclusions Patients with preoperative AF have a lower freedom from TE events after LVAD implant. While overall late survival was not significantly reduced in these patients, refinement in anticoagulation strategies after VAD implant may be required.

Original languageEnglish (US)
Pages (from-to)2161-2167
Number of pages7
JournalAnnals of Thoracic Surgery
Volume96
Issue number6
DOIs
StatePublished - Dec 2013

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Heart-Assist Devices
Atrial Fibrillation
Survival
Thromboembolism
Transient Ischemic Attack
Hemolysis
Thrombosis
Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Preoperative atrial fibrillation increases risk of thromboembolic events after left ventricular assist device implantation. / Stulak, John M.; Deo, Salil; Schirger, John; Aaronson, Keith D.; Park, Soon J.; Joyce, Lyle D.; Daly, Richard C.; Pagani, Francis D.

In: Annals of Thoracic Surgery, Vol. 96, No. 6, 12.2013, p. 2161-2167.

Research output: Contribution to journalArticle

Stulak, JM, Deo, S, Schirger, J, Aaronson, KD, Park, SJ, Joyce, LD, Daly, RC & Pagani, FD 2013, 'Preoperative atrial fibrillation increases risk of thromboembolic events after left ventricular assist device implantation', Annals of Thoracic Surgery, vol. 96, no. 6, pp. 2161-2167. https://doi.org/10.1016/j.athoracsur.2013.07.004
Stulak, John M. ; Deo, Salil ; Schirger, John ; Aaronson, Keith D. ; Park, Soon J. ; Joyce, Lyle D. ; Daly, Richard C. ; Pagani, Francis D. / Preoperative atrial fibrillation increases risk of thromboembolic events after left ventricular assist device implantation. In: Annals of Thoracic Surgery. 2013 ; Vol. 96, No. 6. pp. 2161-2167.
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abstract = "Background Because no series has specifically analyzed the impact of preoperative atrial fibrillation (AF) on patients already at higher risk of thromboembolism after implantation of a left ventricular assist device (LVAD), we review our experience with these patients. Methods Between July 2003 and September 2011, 389 patients (308 male) underwent implantation of a continuous flow LVAD at University of Michigan Hospital and Mayo Clinic. Median age at implant was 60 years (range, 18 to 79 years). Preoperative AF was present in 120 patients (31{\%}). Outcomes were analyzed for the association of preoperative AF and postoperative thromboembolic (TE) events defined as stroke, transient ischemic attack, hemolysis, or pump thrombosis. Thromboembolic events occurring within the first 30 days were not counted. Results One hundred thirty-eight TEs events occurred in 97/389 patients (25{\%}) for an event rate of 0.31 TE events/patient-years of support. Freedom from a TE event in patients with preoperative AF was 62{\%} at 1 year and 46{\%} at 2 years compared with 79{\%} and 72{\%} at 1 and 2 years, respectively, in patients without preoperative AF (p < 0.001). Median survival was 10 months (maximum 7.2 years, total 439 patient-years). Preoperative AF did not decrease late survival at 1 and 2 years after LVAD implant (preop AF: 85{\%} and 70{\%} versus no preop AF: 82{\%} and 70{\%}, respectively; p = 0.55). Conclusions Patients with preoperative AF have a lower freedom from TE events after LVAD implant. While overall late survival was not significantly reduced in these patients, refinement in anticoagulation strategies after VAD implant may be required.",
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AU - Stulak, John M.

AU - Deo, Salil

AU - Schirger, John

AU - Aaronson, Keith D.

AU - Park, Soon J.

AU - Joyce, Lyle D.

AU - Daly, Richard C.

AU - Pagani, Francis D.

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N2 - Background Because no series has specifically analyzed the impact of preoperative atrial fibrillation (AF) on patients already at higher risk of thromboembolism after implantation of a left ventricular assist device (LVAD), we review our experience with these patients. Methods Between July 2003 and September 2011, 389 patients (308 male) underwent implantation of a continuous flow LVAD at University of Michigan Hospital and Mayo Clinic. Median age at implant was 60 years (range, 18 to 79 years). Preoperative AF was present in 120 patients (31%). Outcomes were analyzed for the association of preoperative AF and postoperative thromboembolic (TE) events defined as stroke, transient ischemic attack, hemolysis, or pump thrombosis. Thromboembolic events occurring within the first 30 days were not counted. Results One hundred thirty-eight TEs events occurred in 97/389 patients (25%) for an event rate of 0.31 TE events/patient-years of support. Freedom from a TE event in patients with preoperative AF was 62% at 1 year and 46% at 2 years compared with 79% and 72% at 1 and 2 years, respectively, in patients without preoperative AF (p < 0.001). Median survival was 10 months (maximum 7.2 years, total 439 patient-years). Preoperative AF did not decrease late survival at 1 and 2 years after LVAD implant (preop AF: 85% and 70% versus no preop AF: 82% and 70%, respectively; p = 0.55). Conclusions Patients with preoperative AF have a lower freedom from TE events after LVAD implant. While overall late survival was not significantly reduced in these patients, refinement in anticoagulation strategies after VAD implant may be required.

AB - Background Because no series has specifically analyzed the impact of preoperative atrial fibrillation (AF) on patients already at higher risk of thromboembolism after implantation of a left ventricular assist device (LVAD), we review our experience with these patients. Methods Between July 2003 and September 2011, 389 patients (308 male) underwent implantation of a continuous flow LVAD at University of Michigan Hospital and Mayo Clinic. Median age at implant was 60 years (range, 18 to 79 years). Preoperative AF was present in 120 patients (31%). Outcomes were analyzed for the association of preoperative AF and postoperative thromboembolic (TE) events defined as stroke, transient ischemic attack, hemolysis, or pump thrombosis. Thromboembolic events occurring within the first 30 days were not counted. Results One hundred thirty-eight TEs events occurred in 97/389 patients (25%) for an event rate of 0.31 TE events/patient-years of support. Freedom from a TE event in patients with preoperative AF was 62% at 1 year and 46% at 2 years compared with 79% and 72% at 1 and 2 years, respectively, in patients without preoperative AF (p < 0.001). Median survival was 10 months (maximum 7.2 years, total 439 patient-years). Preoperative AF did not decrease late survival at 1 and 2 years after LVAD implant (preop AF: 85% and 70% versus no preop AF: 82% and 70%, respectively; p = 0.55). Conclusions Patients with preoperative AF have a lower freedom from TE events after LVAD implant. While overall late survival was not significantly reduced in these patients, refinement in anticoagulation strategies after VAD implant may be required.

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