Pulmonary function tests do not predict mortality in patients undergoing continuous-flow left ventricular assist device implantation

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 154; no. 6; pp. 1959 - 1970.e1
• Main Authors: Bedzra, Edo K.S., MD, MBA, Dardas, Todd F., MD, MS, Cheng, Richard K., MD, MS, Pal, Jay D., MD, PhD, Mahr, Claudius, DO, Smith, Jason W., MD, Shively, Kent, BS, Masri, S. Carolina, MD, Levy, Wayne C., MD, Mokadam, Nahush A., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2017
• Subjects: Adult; Aged; Cardiothoracic Surgery; Clinical Decision-Making; Female; Forced Expiratory Volume; heart failure; Heart Failure - diagnosis; Heart Failure - mortality; Heart Failure - physiopathology; Heart Failure - therapy; heart transplantation; Heart-Assist Devices; Hemodynamics; Humans; Intensive Care Units; Length of Stay; Lung - physiopathology; Male; mechanical circulatory support; Middle Aged; Patient Selection; Postoperative Complications - mortality; Postoperative Complications - therapy; Predictive Value of Tests; Prosthesis Design; Pulmonary Diffusing Capacity; pulmonary function tests; Respiratory Function Tests; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Ventricular Function, Left; heart failure; diffusion capacity of the lungs for carbon monoxide; heart transplantation; CI; mechanical circulatory support; LVAD; INTERMACS; LOS; FEV 1; DLCO; Interagency Registry For Mechanically Assisted Circulatory Support; pulmonary function tests; forced expiratory volume in 1 second; length of stay; confidence interval; ICU; intensive care unit; left ventricular assist device; MCS; pulmonary function test; PFT; FEV1
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2017.02.069

Abstract Objectives To investigate the effect of pulmonary function testing on outcomes after continuous flow left ventricular assist device implantation. Methods A total of 263 and 239 patients, respectively, had tests of forced expiratory volume in 1 second and diffusing capacity of the lungs for carbon monoxide preoperatively for left ventricular assist device implantations between July 2005 and September 2015. Kaplan-Meier analysis and multivariable Cox regressions were performed to evaluate mortality. Patients were analyzed in a single cohort and across 5 groups. Postoperative intensive care unit and hospital lengths of stay were evaluated with negative binomial regressions. Results There is no association of forced expiratory volume in 1 second and diffusing capacity of the lungs for carbon monoxide with survival and no difference in mortality at 1 and 3 years between the groups (log rank P  = .841 and .713, respectively). Greater values in either parameter were associated with decreased hospital lengths of stay. Only diffusing capacity of the lungs for carbon monoxide was associated with increased intensive care unit length of stay in the group analysis ( P  = .001). Ventilator times, postoperative pneumonia, reintubation, and tracheostomy rates were similar across the groups. Conclusions Forced expiratory volume in 1 second and diffusing capacity of the lungs for carbon monoxide are not associated with operative or long-term mortality in patients undergoing continuous flow left ventricular assist device implantation. These findings suggest that these abnormal pulmonary function tests alone should not preclude mechanical circulatory support candidacy.