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Original Articles: Adult Cardiac

Incidence and Patterns of Adverse Event Onset During the First 60 Days After Ventricular Assist Device Implantation

^a The Artificial Heart Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
^b Department of Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
^c Department of Biostatistics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
^d Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
^e The Cardiovascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
^f Heart, Lung, Esophageal Surgery Institute, University of Pittsburgh, Pittsburgh, Pennsylvania

Accepted for publication June 9, 2009.

^_* Address correspondence to Dr Dew, University of Pittsburgh School of Medicine and Medical Center, 3811 O'Hara St, Pittsburgh, PA 15213 (Email: dewma{at}upmc.edu).

Background: Although ventricular assist devices (VADs) provide effective treatment for end-stage heart failure, VAD support remains associated with significant risk for adverse events (AEs). To date there has been no detailed assessment of the incidence of a full range of AEs using standardized event definitions. We sought to characterize the frequency and timing of AE onset during the first 60 days of VAD support, a period during which clinical observation suggests the risk of incident AEs is high.

Methods: A retrospective analysis was performed utilizing prospectively collected data from a single-site clinical database including 195 patients aged 18 or greater receiving VADs between 1996 and 2006. Adverse events were coded using standardized criteria. Cumulative incidence rates were determined, controlling for competing risks (death, transplantation, recovery-wean).

Results: During the first 60 days after implantation, the most common AEs were bleeding, infection, and arrhythmias (cumulative incidence rates, 36% to 48%), followed by tamponade, respiratory events, reoperations, and neurologic events (24% to 31%). Other events (eg, hemolysis, renal, hepatic events) were less common (rates <15%). Some events (eg, bleeding, arrhythmias) showed steep onset rates early after implantation. Others (eg, infections, neurologic events) had gradual onsets during the 60-day period. Incidence of most events did not vary by implant era (1996 to 2000 vs 2001 to 2006) or by left ventricular versus biventricular support.

Conclusions: Understanding differential temporal patterns of AE onset will allow preventive strategies to be targeted to the time periods when specific AE risks are greatest. The AE incidence rates provide benchmarks against which future studies of VAD-related risks may be compared.

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