Gender differences and outcomes in left ventricular assist device support: The European Registry for Patients with Mechanical Circulatory Support
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Gender differences and outcomes in left ventricular assist device support: The European Registry for Patients with Mechanical Circulatory Support. / Magnussen, Christina; Bernhardt, Alexander M; Ojeda, Francisco M; Wagner, Florian M; Gummert, Jan; de By, Theo M M H; Krabatsch, Thomas; Mohacsi, Paul; Rybczynski, Meike; Knappe, Dorit; Sill, Bjoern; Deuse, Tobias; Blankenberg, Stefan; Schnabel, Renate B; Reichenspurner, Hermann.
in: J HEART LUNG TRANSPL, Jahrgang 37, Nr. 1, 01.2018, S. 61-70.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung
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TY - JOUR
T1 - Gender differences and outcomes in left ventricular assist device support: The European Registry for Patients with Mechanical Circulatory Support
AU - Magnussen, Christina
AU - Bernhardt, Alexander M
AU - Ojeda, Francisco M
AU - Wagner, Florian M
AU - Gummert, Jan
AU - de By, Theo M M H
AU - Krabatsch, Thomas
AU - Mohacsi, Paul
AU - Rybczynski, Meike
AU - Knappe, Dorit
AU - Sill, Bjoern
AU - Deuse, Tobias
AU - Blankenberg, Stefan
AU - Schnabel, Renate B
AU - Reichenspurner, Hermann
N1 - Copyright © 2018 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
PY - 2018/1
Y1 - 2018/1
N2 - BACKGROUND: Despite the increasing use of ventricular assist devices (VADs), gender differences in indications, hemodynamics, and outcome are not well understood. We examined gender differences and gender-specific predictors for perioperative outcome in patients on ventricular support.METHODS: Multicenter data of 966 patients (median age 55 years, 151 women) from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) were analyzed. Median follow-up was 1.26 years.RESULTS: At the time of VAD implantation, women were more often in an unstable condition (Interagency Registry for Mechanically Assisted Circulatory Support [INTERMACS] profile 1 and 2) (51.7% vs 41.6% in men), experiencing significantly more often major bleeding (p = 0.0012), arrhythmias (p = 0.022), and right ventricular (RV) failure (p < 0.001) with need for additional RV support. The survival of women on isolated LVAD support was significantly worse (1-year survival 75.5% vs 83.2% in men). Age-adjusted Cox regression analyses showed significant associations with mortality for preoperative inotropic therapy, percutaneous mechanical support, INTERMACS profile 1 and 2, RV dysfunction, major bleeding, cerebral bleeding, ischemic stroke, and RV failure. In women, pump thrombosis was more strongly related with mortality compared to men, while the direction of the association of renal dysfunction with mortality was different for women and men (p-value interaction 0.028 and 0.023, respectively).CONCLUSIONS: Women and men differ in perioperative hemodynamics, adverse events, and mortality after VAD implantation. A gender-dependent association of pump thrombosis with mortality was seen. The impact on treatment practice needs to be shown.
AB - BACKGROUND: Despite the increasing use of ventricular assist devices (VADs), gender differences in indications, hemodynamics, and outcome are not well understood. We examined gender differences and gender-specific predictors for perioperative outcome in patients on ventricular support.METHODS: Multicenter data of 966 patients (median age 55 years, 151 women) from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) were analyzed. Median follow-up was 1.26 years.RESULTS: At the time of VAD implantation, women were more often in an unstable condition (Interagency Registry for Mechanically Assisted Circulatory Support [INTERMACS] profile 1 and 2) (51.7% vs 41.6% in men), experiencing significantly more often major bleeding (p = 0.0012), arrhythmias (p = 0.022), and right ventricular (RV) failure (p < 0.001) with need for additional RV support. The survival of women on isolated LVAD support was significantly worse (1-year survival 75.5% vs 83.2% in men). Age-adjusted Cox regression analyses showed significant associations with mortality for preoperative inotropic therapy, percutaneous mechanical support, INTERMACS profile 1 and 2, RV dysfunction, major bleeding, cerebral bleeding, ischemic stroke, and RV failure. In women, pump thrombosis was more strongly related with mortality compared to men, while the direction of the association of renal dysfunction with mortality was different for women and men (p-value interaction 0.028 and 0.023, respectively).CONCLUSIONS: Women and men differ in perioperative hemodynamics, adverse events, and mortality after VAD implantation. A gender-dependent association of pump thrombosis with mortality was seen. The impact on treatment practice needs to be shown.
KW - Europe
KW - Female
KW - Heart Failure/surgery
KW - Heart-Assist Devices
KW - Humans
KW - Male
KW - Middle Aged
KW - Registries
KW - Sex Factors
KW - Treatment Outcome
U2 - 10.1016/j.healun.2017.06.016
DO - 10.1016/j.healun.2017.06.016
M3 - SCORING: Journal article
C2 - 28754423
VL - 37
SP - 61
EP - 70
JO - J HEART LUNG TRANSPL
JF - J HEART LUNG TRANSPL
SN - 1053-2498
IS - 1
ER -
