Advertisement

Journal of Artificial Organs

, Volume 20, Issue 4, pp 311–317 | Cite as

Readmissions after continuous flow left ventricular assist device implantation

  • Mitsutoshi KimuraEmail author
  • Kan Nawata
  • Osamu Kinoshita
  • Haruo Yamauchi
  • Yasuhiro Hoshino
  • Masaru Hatano
  • Eisuke Amiya
  • Koichi Kashiwa
  • Miyoko Endo
  • Yukie Kagami
  • Mariko Nemoto
  • Minoru Ono
Original Article Artificial Heart (Clinical)

Abstract

Continuous flow left ventricular assist device (CF-LVAD) therapy has improved the survival of patients with advanced heart failure. However, the readmission rate of CF-LVAD patients is still relatively high. A total of 90 patients who received CF-LVADs between April 2011 and March 2016 at our institute and were discharged home were analyzed retrospectively. They were followed up through March 2017. Clinical data, including frequency, length and etiology of readmission, were obtained from medical records. The mean observation period after initial discharge was 713 ± 322 days. In total, 73 patients (81%) had 236 readmissions, 214 unplanned and 22 planned. The overall and unplanned readmission rates were 1.34 and 1.22 per patient-year, respectively. The rate of freedom from unplanned first readmission at 1 year after initial discharge was 39%. The median interval between the previous hospital discharge and first and second readmissions was 311 and 213 days, respectively (log-rank test, p = 0.117). The rate of readmission after more than three readmissions was significantly higher than that of first or second readmission (log-rank test, p < 0.001). The most common etiology of readmission was driveline infection (DLI) (36%), followed by stroke (9%). The median length of hospital stay due to DLI was 23 days. The patients with repeated unplanned readmissions had significantly lower EuroQol 5 dimensions questionnaire utility score than those with no or just one readmission. Readmission was common in CF-LVAD patients, and the most common etiology of readmissions was DLI. The interval to the next readmission seemed shorter for patients with repeated readmissions.

Keywords

Left ventricular assist device Continuous flow Readmission Driveline infection 

Notes

Compliance with ethical standards

Conflict of interest

Kan Nawata belongs to Department of Healthcare Quality Assessment, which is an social cooperation program sponsored by National Clinical Database [34] and 2 companies including Nipro Corp. (Osaka, Japan). Masaru Hatano belongs to Department of Therapeutic Strategy for Heart Failure, which is an endowed department sponsored by 14 companies including Terumo Corp. (Tokyo, Japan) and Century Medical Inc. (Tokyo, Japan). The others have no conflict of interest.

References

  1. 1.
    Miller LW, Pagani FD, Russell SD, et al. Use of a continuous-flow device in patients awaiting heart transplantation. N Engl J Med. 2007;357:885–96.CrossRefPubMedGoogle Scholar
  2. 2.
    Jakovljevic DG, McDiarmid A, Hallsworth K, et al. Effect of left ventricular assist device implantation and heart transplantation on habitual physical activity and quality of life. Am J Cardiol. 2014;114:88–93.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Kato NP, Okada I, Imamura T, et al. Quality of life and influential factors in patients implanted with a left ventricular assist device. Circ J. 2015;79:2186–92.CrossRefPubMedGoogle Scholar
  4. 4.
    Nishinaka T, Schima H, Roethy W, et al. The DuraHeart VAD, a magnetically levitated centrifugal pump: the University of Vienna bridge-to-transplant experience. Circ J. 2006;70:1421–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Sakaguchi T, Matsumiya G, Yoshioka D, et al. DuraHeart magnetically levitated left ventricular assist device: Osaka University experience. Circ J. 2013;77:1736–41.CrossRefPubMedGoogle Scholar
  6. 6.
    Saito S, Yamazaki K, Nishinaka T, et al. Post-approval study of a highly pulsed, low-shear-rate, continuous-flow, left ventricular assist device, EVAHEART: a Japanese multicenter study using J-MACS. J Heart Lung Transpl. 2014;33:599–608.CrossRefGoogle Scholar
  7. 7.
    Kyo S, Minami T, Nishimura T, Gojo S, Ono M. New era for therapeutic strategy for heart failure: destination therapy by left ventricular assist device. J Cardiol. 2012;59:101–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Ono M, Sawa Y, Nakatani T, et al. Japanese multicenter outcomes with the HeartMate II left ventricular assist device in patients with small body surface area. Circ J. 2016;80:1931–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Yoshioka D, Matsumiya G, Toda K, et al. Clinical results with Jarvik 2000 axial flow left ventricular assist device: Osaka University Experience. J Artif Organs. 2014;17:308–14.CrossRefPubMedGoogle Scholar
  10. 10.
    Kirklin JK, Naftel DC, Pagani FD, et al. Seventh INTERMACS annual report: 15,000 patients and counting. J Heart Lung Transp. 2015;34:1495–504.CrossRefGoogle Scholar
  11. 11.
    Saito S. Towards destination therapy with left ventricular assist devices in Japan. Gen Thorac Cardiovasc Surg. 2015;63:537–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Toda K, Sawa Y. Clinical management for complications related to implantable LVAD use. Gen Thorac Cardiovasc Surg. 2015;63:1–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Da Silva M, MacIver J, Rodger M, et al. Readmissions following implantation of a continuous-flow left ventricular assist device. J Card Surg. 2016;31:361–4.CrossRefPubMedGoogle Scholar
  14. 14.
    Forest SJ, Bello R, Friedmann P, et al. Readmissions after ventricular assist device: etiologies, patterns, and days out of hospital. Ann Thorac Surg. 2013;95:1276–81.CrossRefPubMedGoogle Scholar
  15. 15.
    Rossing K, Jung MH, Sander K, et al. Outcomes and hospital admissions during long-term support with a HeartMate II. Scand Cardiovasc J. 2015;49:367–75.PubMedGoogle Scholar
  16. 16.
    Smedira NG, Hoercher KJ, Lima B, et al. Unplanned hospital readmissions after HeartMate II implantation: frequency, risk factors, and impact on resource use and survival. JACC Heart Fail. 2013;1:31–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Hata H, Fujita T, Shimahara Y, et al. Early and mid-term outcomes of left ventricular assist device implantation and future prospects. Gen Thorac Cardiovasc Surg. 2015;63:557–64.CrossRefPubMedGoogle Scholar
  18. 18.
    Kimura M, Kinoshita O, Nawata K, et al. Midterm outcome of implantable left ventricular assist devices as a bridge to transplantation: single-center experience in Japan. J Cardiol. 2015;65:383–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Baras Shreibati J, Goldhaber-Fiebert JD, Banerjee D, Owens DK, Hlatky MA. Cost-effectiveness of left ventricular assist devices in ambulatory patients with advanced heart failure. JACC Heart Fail. 2017;5:110–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Moazami N, Steffen RJ, Naka Y, et al. Lessons learned from the first fully magnetically levitated centrifugal LVAD trial in the United States: the DuraHeart trial. Ann Thorac Surg. 2014;98:541–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Potapov EV, Kaufmann F, Stepanenko A, et al. Pump exchange for cable damage in patients supported with HeartMate II left ventricular assist device. ASAIO J. 2012;58:578–82.CrossRefPubMedGoogle Scholar
  22. 22.
    Takura T, Kyo S, Ono M, et al. Preliminary report on the cost effectiveness of ventricular assist devices. J Artif Organs. 2016;19:37–43.CrossRefPubMedGoogle Scholar
  23. 23.
    Team JET. The development of Japanese EuroQol instrument. Iryo Shakai. 1998;8:109–23.Google Scholar
  24. 24.
    Itoda Y, Nawata K, Yamauchi H, et al. Central aortic valve closure successfully treated aortic insufficiency of the patient with Jarvik 2000 continuous flow left ventricular assist device: a case report. J Artif Organs. 2017;20:99–101.CrossRefPubMedGoogle Scholar
  25. 25.
    Imamura T, Kinugawa K, Nitta D, et al. Fontan-like hemodynamics complicated with ventricular fibrillation during left ventricular assist device support. Int Heart J. 2016;57:515–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Naito N, Kinoshita O, Ono M. Prolonged left ventricular assist device support (18 months) in refractory ventricular fibrillation. J Heart Lung Transpl. 2014;33:772–3.CrossRefGoogle Scholar
  27. 27.
    Patel SR, Oh KT, Ogriki T, et al. Cessation of continuous flow left ventricular assist device-related gastrointestinal bleeding after heart transplantation. ASAIO J. 2017. doi: 10.1097/MAT.0000000000000624.PubMedCentralGoogle Scholar
  28. 28.
    Akhter SA, Badami A, Murray M, et al. Hospital readmissions after continuous-flow left ventricular assist device implantation: incidence, causes, and cost analysis. Ann Thorac Surg. 2015;100:884–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Kimura M, Nishimura T, Kinoshita O, et al. Successful treatment of pump pocket infection after left ventricular assist device implantation by negative pressure wound therapy and omental transposition. Ann Thorac Cardiovasc Surg. 2014;20:842–5.CrossRefPubMedGoogle Scholar
  30. 30.
    Tanaka S, Nawata K, Kitahara H, et al. A successful management of infection of the left ventricular assist device by pump exchange: conversion from DuraHeart to Jarvik 2000. J Artif Organs. 2016;19:387–91.CrossRefPubMedGoogle Scholar
  31. 31.
    Jennings DL, Chopra A, Chambers R, Morgan JA. Clinical outcomes associated with chronic antimicrobial suppression therapy in patients with continuous-flow left ventricular assist devices. Artif Organs. 2014;38:875–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Haglund NA, Davis ME, Tricarico NM, Keebler ME, Maltais S. Readmissions after continuous flow left ventricular assist device implantation: differences observed between two contemporary device types. ASAIO J. 2015;61:410–6.CrossRefPubMedGoogle Scholar
  33. 33.
    Kimura M, Nawata K, Kinoshita O, et al. Cerebrovascular accident rate is different between centrifugal and axial-flow pumps, but survival and driveline infection rates are similar. Transpl Proc. 2017;49:121–4.CrossRefGoogle Scholar
  34. 34.
    Miyata H, Gotoh M, Hashimoto H, et al. Challenges and prospects of a clinical database linked to the board certification system. Surg Today. 2014;44:1991–9.CrossRefPubMedGoogle Scholar

Copyright information

© The Japanese Society for Artificial Organs 2017

Authors and Affiliations

  • Mitsutoshi Kimura
    • 1
    Email author
  • Kan Nawata
    • 1
    • 2
  • Osamu Kinoshita
    • 1
  • Haruo Yamauchi
    • 1
  • Yasuhiro Hoshino
    • 1
  • Masaru Hatano
    • 3
    • 4
  • Eisuke Amiya
    • 3
  • Koichi Kashiwa
    • 5
  • Miyoko Endo
    • 6
  • Yukie Kagami
    • 6
  • Mariko Nemoto
    • 6
  • Minoru Ono
    • 1
  1. 1.Department of Cardiac SurgeryThe University of TokyoTokyoJapan
  2. 2.Department of Healthcare Quality AssessmentThe University of TokyoTokyoJapan
  3. 3.Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
  4. 4.Department of Therapeutic Strategy for Heart FailureThe University of TokyoTokyoJapan
  5. 5.Department of Medical EngineeringThe University of Tokyo HospitalTokyoJapan
  6. 6.Division of Organ Transplantation ServiceThe University of Tokyo HospitalTokyoJapan

Personalised recommendations