Impact of Postoperative Liver Dysfunction on Survival After Left Ventricular Assist Device Implantation

Kaustav Majumder; John R Spratt; Christopher T Holley; Samit S Roy; Rebecca J Cogswell; Kenneth Liao; Ranjit John

doi:10.1016/j.athoracsur.2017.04.048

Impact of Postoperative Liver Dysfunction on Survival After Left Ventricular Assist Device Implantation

Ann Thorac Surg. 2017 Nov;104(5):1556-1562. doi: 10.1016/j.athoracsur.2017.04.048. Epub 2017 Jul 29.

Authors

Kaustav Majumder¹, John R Spratt¹, Christopher T Holley¹, Samit S Roy², Rebecca J Cogswell², Kenneth Liao³, Ranjit John⁴

Affiliations

¹ Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
² Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
³ Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
⁴ Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota. Electronic address: johnx008@umn.edu.

PMID: 28760474
DOI: 10.1016/j.athoracsur.2017.04.048

Abstract

Background: Liver dysfunction in left ventricular assist device (LVAD) recipients is common both before and after implantation. Postoperative liver dysfunction (PLD) develops in some LVAD recipients without preoperative liver dysfunction. The aim of this study was to assess clinical outcomes in such patients.

Methods: Records of all patients undergoing implantation of a HeartMate II (HM II, St. Jude Medical, Inc, Minneapolis, MN) LVAD at a single center at the University of Minnesota from January 2005 through June 2014 were analyzed. PLD was defined by hypertransaminasemia or hyperbilirubinemia, or both, during the hospitalization for LVAD implantation.

Results: During the study period, 284 patients underwent HM II implantation. Excluded from analysis were 14 recipients with preoperative liver dysfunction. In the final cohort (n = 270), there were no major difference in preoperative characteristics among those patients with versus without PLD. PLD developed in 129 (47.8%) recipients: 16 (12.4%) had isolated hypertransaminasemia (group I), 76 (58.9%) had isolated hyperbilirubinemia (group II), and 37 (28.7%) had combined hypertransaminasemia and hyperbilirubinemia (group III). Group III LVAD recipients had significantly greater rates of 30-day, 90-day, and 1-year mortality, along with significantly higher transfusion requirements and higher rates of renal replacement therapy, prolonged ventilation, and vasopressor use. Moreover, their mortality risk was significantly higher than that of PLD-free LVAD recipients (hazard ratio, 4.6; 95% confidence interval, 2.1 to 10.1; p < 0.001).

Conclusions: Isolated hyperbilirubinemia is common after LVAD implantation. In this study, it was not associated with an increase in early or midterm postoperative mortality. However, postoperative combined transaminasemia and hyperbilirubinemia was associated with a significant increase in early and midterm morbidity and mortality. Further research into the pathogenesis of post-LVAD PLD is necessary.

Publication types

Comparative Study

MeSH terms

Adult
Aged
Analysis of Variance
Cardiac Surgical Procedures / methods
Cardiac Surgical Procedures / mortality
Cause of Death*
Cohort Studies
Databases, Factual
Female
Heart Failure / mortality*
Heart Failure / surgery*
Heart-Assist Devices / adverse effects*
Hospital Mortality
Humans
Hyperbilirubinemia / etiology
Hyperbilirubinemia / physiopathology
Kaplan-Meier Estimate
Liver Diseases / etiology*
Liver Diseases / mortality*
Liver Diseases / pathology
Logistic Models
Male
Middle Aged
Multivariate Analysis
Postoperative Complications / mortality
Postoperative Complications / physiopathology
Prognosis
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Survival Analysis
Treatment Outcome