Original articleAdult cardiacPreoperative Atrial Fibrillation Increases Risk of Thromboembolic Events After Left Ventricular Assist Device Implantation
Section snippets
Study Population
The data collection process and analysis was performed after informed patient consent and approved by the University of Michigan and Mayo Foundation Institutional Review Board. Between July 2003 and September 2011, 389 patients (308 men) 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); 95 patients were younger than 50 years, 232 were between 50 and 70 years, and 62 were older than 70
Results
Median follow-up was 10 months (maximum 7.2 years, total 439 patient-years) and was available in all early survivors (n = 365).
There were 138 TE events in 97 patients (25%; 97 of 389 patients); this was a single event in 66 patients (68%; 66 of 97 patients) and a multiple event in 31 patients (32%; 31 of 97 patients). Of the TE events, 49 were suspected or confirmed pump thrombus, 48 were hemolysis, 33 were stroke, and 8 were TIA; the overall rate of any TE event in this cohort was 0.31 per
Comment
We demonstrate in this study that preoperative AF in patients undergoing VAD implantation represents a significant risk factor for the development of TE events during follow-up. This finding was most significant for patients who were younger than 70 years at the time of implant. We observed that while both the incidence of preoperative AF and postoperative TE events increased with increasing age at implant, interestingly, increasing age was not an independent predictor of TE events. The
References (20)
- et al.
Improving survival for patients with atrial fibrillation and advanced heart failure
J Am Coll Cardiol
(1996) - et al.
Third INTERMACS annual report: the evolution of destination therapy in the United States
J Heart Lung Transplant
(2011) - et al.
The fourth INTERMACS annual report: 4,000 implants and counting
J Heart Lung Transplant
(2012) - et al.
Long-term mechanical circulatory support (destination therapy): On track to compete with heart transplantation?
J Thorac Cardiovasc Surg
(2012) - et al.
Pre-operative and post-operative risk factors associated with neurologic complications in patients with advanced heart failure supported by a left ventricular assist device
J Heart Lung Transplant
(2012) - et al.
Activation of endothelial and coagulation systems in left ventricular assist device recipients
Ann Thorac Surg
(2009) - et al.
Low thromboembolism and pump thrombosis with the HeartMate II left ventricular assist device: analysis of outpatient anticoagulation
J Heart Lung Transplant
(2009) - et al.
Low thromboembolic risk for patients with the HeartMate II left ventricular assist device
J Thorac Cardiovasc Surg
(2008) - et al.
Effect of atrial fibrillation on atrial thrombogenesis in humans: impact of rate and rhythm
J Am Coll Cardiol
(2013) - et al.
Lifetime risk for development of atrial fibrillation: the Framingham Heart Study
Circulation
(2004)