Periportal fibrosis without cirrhosis does not affect outcomes after continuous flow ventricular assist device implantation

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 151; no. 1; pp. 230 - 235
• Main Authors: Sargent, Jonathon E., BS, Dardas, Todd F., MD, MS, Smith, Jason W., MD, Pal, Jay D., MD, PhD, Cheng, Richard K., MD, MS, Masri, S. Carolina, MD, Shively, Kent R., BS, Colyer, Lauren M., BS, Mahr, Claudius, DO, Mokadam, Nahush A., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2016
• Subjects: Adult; Aged; Biopsy; Cardiothoracic Surgery; Female; Gastrointestinal Hemorrhage - etiology; heart failure; Heart Failure - complications; Heart Failure - diagnosis; Heart Failure - mortality; Heart Failure - physiopathology; Heart Failure - therapy; heart-assist devices; Heart-Assist Devices - adverse effects; Humans; Kaplan-Meier Estimate; Length of Stay; Liver Cirrhosis - complications; Liver Cirrhosis - diagnosis; Liver Cirrhosis - mortality; liver diseases; Male; Middle Aged; Patient Selection; Prosthesis Design; Retrospective Studies; Risk Assessment; Risk Factors; survival analysis; Time Factors; Treatment Outcome; Ventricular Function; heart failure; model for end-stage liver disease; 27; heart-assist devices; mechanical circulatory support; INR; international normalized ratio; Interagency Registry for Mechanically Assisted Circulatory Support; INTERMACS; ventricular assist device; LOS; survival analysis; MELD; length of stay; VAD; liver diseases; MCS; 27.2
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2015.08.073

Abstract Objective This study investigates the relationship of periportal fibrosis on postoperative outcomes after ventricular assist device (VAD) implantation. Methods Between July 2005 and August 2014, a total of 233 patients were implanted with continuous flow VADs. Liver biopsy was performed on 16 patients with concern for liver disease. Survival was evaluated using the Kaplan-Meier method. The effect of fibrosis on length of stay (LOS) in the intensive care unit was modeled using Poisson regression. Adjustments were made for age, profile from the Interagency Registry for Mechanically Assisted Circulatory Support, biopsy, and model for end-stage liver disease score. Results Fourteen of the 16 patients who underwent biopsy had periportal fibrosis without cirrhosis. One-year survival for the groups with and without biopsy-proven fibrosis was 93% ± 7% and 86% ± 2% ( P  = .97), respectively. The intensive care unit LOS was not different for those with (median, 7 days; interquartile range: 3-14 days) versus without fibrosis (median, 6 days; interquartile range 4-10 days; P  = .65). Fibrosis ( P  = .42), age (0.95), model for end-stage liver disease excluding internal normalized ratio–XI score ( P  = .64), performance of a biopsy ( P  = .28), and Interagency Registry for Mechanically Assisted Circulatory Support class ( P  = .70) were not associated with intensive care unit LOS. Risk was increased of gastrointestinal bleeding (14% vs 4%; P  = .026) in the first year among patients with fibrosis. Conclusions The presence of periportal fibrosis did not affect survival or outcomes in patients undergoing VAD implantation. These findings suggest that carefully selected patients with advanced heart failure and hepatic fibrosis without cirrhosis may achieve acceptable outcomes with VAD implantation.