TY - JOUR
T1 - Sex Disparities in Left Ventricular Assist Device Implantation
T2 - Delayed Presentation and Worse Right Heart Failure
AU - Lamba, Harveen K.
AU - Kherallah, Riyad
AU - Nair, Ajith P.
AU - Shafii, Alexis E.
AU - Loor, Gabriel
AU - Kassi, Mahwash
AU - Chatterjee, Subhasis
AU - Rogers, Joseph G.
AU - Civitello, Andrew B.
AU - Liao, Kenneth K.
N1 - Publisher Copyright:
Copyright © ASAIO 2024.
PY - 2024/6/1
Y1 - 2024/6/1
N2 - We explored whether women undergo continuous-flow left ventricular assist device (CF-LVAD) implantation in later stages of heart failure (HF) than men, evidenced by worse preoperative right HF (RHF). We also compared two propensity models with and without preoperative RHF to assess its effect on outcomes. INTERMACS was queried from July 2008 to December 2017. Propensity model 1 matched men and women on age ≥50 years, HF etiology, body surface area, INTERMACS class, comorbidities, device strategy, temporary mechanical circulatory support, and device type. Model 2 included these variables plus LV end-diastolic diameter, right atrial pressure/pulmonary capillary wedge pressure, pulmonary artery pulsatility index, and right ventricular ejection fraction. The primary outcome was all-cause mortality. Secondary outcomes comprise RHF, rehospitalization, renal dysfunction, stroke, and device malfunction. In model 1, characteristics were comparable between 3,195 women and 3,195 men, except women more often had preoperative RHF and postoperative right VAD support and had worse 1 year and overall survival. In model 2, after propensity matching for additional risk factors for preoperative RHF, 1,119 women and 1,119 men had comparable post-LVAD implant RVAD use and survival. These findings suggest that women present more often with biventricular failure and after implantation have higher RHF and mortality rates.
AB - We explored whether women undergo continuous-flow left ventricular assist device (CF-LVAD) implantation in later stages of heart failure (HF) than men, evidenced by worse preoperative right HF (RHF). We also compared two propensity models with and without preoperative RHF to assess its effect on outcomes. INTERMACS was queried from July 2008 to December 2017. Propensity model 1 matched men and women on age ≥50 years, HF etiology, body surface area, INTERMACS class, comorbidities, device strategy, temporary mechanical circulatory support, and device type. Model 2 included these variables plus LV end-diastolic diameter, right atrial pressure/pulmonary capillary wedge pressure, pulmonary artery pulsatility index, and right ventricular ejection fraction. The primary outcome was all-cause mortality. Secondary outcomes comprise RHF, rehospitalization, renal dysfunction, stroke, and device malfunction. In model 1, characteristics were comparable between 3,195 women and 3,195 men, except women more often had preoperative RHF and postoperative right VAD support and had worse 1 year and overall survival. In model 2, after propensity matching for additional risk factors for preoperative RHF, 1,119 women and 1,119 men had comparable post-LVAD implant RVAD use and survival. These findings suggest that women present more often with biventricular failure and after implantation have higher RHF and mortality rates.
KW - Humans
KW - Middle Aged
KW - Sex Factors
KW - Ventricular Dysfunction, Right/physiopathology
KW - Heart-Assist Devices/adverse effects
KW - Female
KW - Male
KW - Heart Failure/surgery
KW - Aged
KW - Retrospective Studies
UR - http://www.scopus.com/inward/record.url?scp=85194417667&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85194417667&partnerID=8YFLogxK
U2 - 10.1097/MAT.0000000000002134
DO - 10.1097/MAT.0000000000002134
M3 - Article
C2 - 38181411
AN - SCOPUS:85194417667
SN - 1058-2916
VL - 70
SP - 469
EP - 476
JO - ASAIO journal (American Society for Artificial Internal Organs : 1992)
JF - ASAIO journal (American Society for Artificial Internal Organs : 1992)
IS - 6
ER -