Temporal differences in causes of mortality after left ventricular assist device implantation

Background The risk of device-related adverse events leading to death is abundant and ever-present after left ventricular assist device (VAD) implantation. Very few data specifically examine the causes of death related to length of time after VAD implantation. Methods Between October 2004 and February 2013, 493 patients (395 male, 80%) underwent primary continuous-flow VAD implantation at our institutions. The median age at implantation was 60 years (range, 18-79 years), and 301 patients (62%) underwent bridge to transplantation. Results Follow-up was available for all patients (median, 13 months) for a total of 717 patient-years of support. There were 132 deaths during follow-up (median, 8 months; early, 5.5 years) after VAD implantation. The patients were grouped according to temporal occurrence of deaths: (1) early (30-day or index hospitalization) in 34 of 132 patients (26%), (2) between hospital dismissal and 6 months in 29 of 132 patients (22%), (3) 6 months to 1 year in 14 of 132 patients (11%), and (4) after 1 year in 55 of 132 patients (42%). The causes of death (%) at each time period are presented; the most common early cause was right ventricular failure/multisystem organ failure in 18 of 34 patients (61%); from dismissal to 6 months, and 6 months to 1 year, cerebral hemorrhage in 6 of 29 patients (21%) and 4 of 14 patients (29%), respectively; after 1 year, cerebral hemorrhage in 12 of 55 patients (22%) and right ventricular failure/multisystem organ failure in 11 of 55 patients (20%). Conclusions The causes of death vary according to time after VAD implantation. Understanding the temporal relationship of causes of mortality after VAD implantation is critical to the identification of varying specific risks in an effort to avoid morbidity, which may ultimately detract from a durable VAD outcome.