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Erschienen in: Journal of Artificial Organs 4/2013

01.12.2013 | Original Article

Prediction of outcome in patients with liver dysfunction after left ventricular assist device implantation

verfasst von: Hiroyuki Nishi, Koichi Toda, Shigeru Miyagawa, Yasushi Yoshikawa, Satsuki Fukushima, Daisuke Yoshioka, Tetsuya Saito, Shunsuke Saito, Taichi Sakaguchi, Takayoshi Ueno, Toru Kuratani, Yoshiki Sawa

Erschienen in: Journal of Artificial Organs | Ausgabe 4/2013

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Abstract

Although postoperative liver dysfunction (LD) following left ventricular assist device (LVAD) implantation is associated with high mortality, outcome is difficult to predict in patients with liver dysfunction. We aimed to clarify factors affecting recovery from LD after VAD implantation. A total of 167 patients underwent LVAD implantation, of whom 101 developed early postoperative LD, defined as maximum total bilirubin (max T-bil) greater than 5.0 mg/dl within 2 weeks. We set two different end-points, unremitting LD, and 90-day mortality. The rates of early mortality (90 days) and recovery from LD were 36 % (36/101) and 72 % (73/101), respectively. Univariate analysis showed that preoperative body weight, preoperative mechanical support, preoperative T-bil and creatinine, left ventricular diastolic dimension, right VAD (RVAD) insertion, cardiopulmonary bypass time, postoperative cardiac index, and postoperative T-bil and central venous pressure (CVP) on postoperative day (POD) 3 (non-recovered vs recovered, 12.4 ± 4.5 vs 9.5 ± 3.6 mmHg) were higher in patients with unremitting LD. Preoperative T-bil, RVAD insertion, and T-bil and CVP on POD 3 (non-survivor vs survivor, 12.4 ± 4.4 vs 9.4 ± 3.6 mmHg) were also higher in non-survivors. Multivariate analysis demonstrated that CVP on POD 3 was predictive of recovery from postoperative LD (OR 0.730, P < 0.05) and 90-day mortality (OR 0.730, P < 0.05). A key outcome factor in patients who developed early postoperative LD after LVAD implantation was postoperative liver congestion with high CVP. To overcome postoperative LD, appropriate management of postoperative CVP level is important.
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Metadaten
Titel
Prediction of outcome in patients with liver dysfunction after left ventricular assist device implantation
verfasst von
Hiroyuki Nishi
Koichi Toda
Shigeru Miyagawa
Yasushi Yoshikawa
Satsuki Fukushima
Daisuke Yoshioka
Tetsuya Saito
Shunsuke Saito
Taichi Sakaguchi
Takayoshi Ueno
Toru Kuratani
Yoshiki Sawa
Publikationsdatum
01.12.2013
Verlag
Springer Japan
Erschienen in
Journal of Artificial Organs / Ausgabe 4/2013
Print ISSN: 1434-7229
Elektronische ISSN: 1619-0904
DOI
https://doi.org/10.1007/s10047-013-0724-2

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