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Sex differences in continuous-flow ventricular assist device therapy for advanced heart failure

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General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Objective

The effect of patient sex in continuous-flow ventricular assist device (c-VAD) therapy has not been well described. We investigated sex-specific differences in clinical outcomes related to c-VAD therapy for Japanese patients.

Methods

We retrospectively analyzed 153 patients, including 41 (27%) female patients who underwent c-VAD implantation over the last 13 years in our institution for a mean follow-up of 766 ± 446 days. Clinical outcomes were compared between male and female patients

Results

There was no significant difference in mortality, cerebral vascular accidents, the severity of heart failure, or driveline infection in patients who underwent c-VAD implantation, regardless of sex. While male patients tended to have more bleeding at the time of surgery, female patients had significantly higher rates of non-surgical bleeding during subsequent c-VAD therapy, mainly from gynecological origins.

Conclusions

Female patients treated with c-VAD had a significantly higher incidence of non-surgical bleeding events. Careful attention to gynecological complications and sex-specific care is required in female patients with c-VAD.

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References

  1. O’Donnell MJ, Xavier D, Liu LS, Zhang HY, Chin SL, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010;376:112–23.

    Article  Google Scholar 

  2. Hsia J, Margolis KL, Eaton CB, Wenger NK, Allison M, Wu L, et al. Prehypertension and cardiovascular disease risk in the Women’s Health Initiative. Circulation. 2007;115:855–60.

    Article  Google Scholar 

  3. Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the national registry of atrial fibrillation. JAMA. 2001;285:2864–70.

    Article  CAS  Google Scholar 

  4. Avgil Tsadok M, Jackevicius CA, Rahme E, Humphries KH, Behlouli H, Pilote L. Sex differences in stroke risk among older patients with recently diagnosed atrial fibrillation. JAMA. 2012;307:1952–8.

    Article  Google Scholar 

  5. Boden-Albala B, Sacco RL, Lee HS, Grahame-Clarke C, Rundek T, Elkind MV, et al. Metabolic syndrome and ischemic stroke risk: Northern Manhattan Study. Stroke. 2008;39:30–5.

    Article  Google Scholar 

  6. Ninomiya JK, L’Italien G, Criqui MH, Whyte JL, Gamst A, Chen RS. Association of the metabolic syndrome with history of myocardial infarction and stroke in the third national health and nutrition examination survey. Circulation. 2004;109:42–6.

    Article  Google Scholar 

  7. Potapov E, Schweiger M, Lehmkuhl E, Vierecke J, Stepanenko A, Weng G, et al. Gender differences during mechanical circulatory support. ASAIO J. 2012;58:320–5.

    Article  Google Scholar 

  8. McIlvennan CK, Lindenfeld J, Kao DP. Sex differences and in-hospital outcomes in patients undergoing mechanical circulatory support implantation. J Heart Lung Transplant. 2017;36:82–90.

    Article  Google Scholar 

  9. Magnussen C, Bernhardt AM, Ojeda FM, Wagner FM, Gummert J, de By T, et al. Gender differences and outcomes in left ventricular assist device support: the european registry for patients with mechanical circulatory support. J Heart Lung Transplant. 2018;37:61–70.

    Article  Google Scholar 

  10. Meeteren JV, Maltais S, Dunlay SM, Haglund NA, Beth Davis M, Cowger J, et al. A multi-institutional outcome analysis of patients undergoing left ventricular assist device implantation stratified by sex and race. J Heart Lung Transplant. 2017;36:64–70.

    Article  Google Scholar 

  11. Morgan JA, Weinberg AD, Hollingsworth KW, Flannery MR, Oz MC, Naka Y. Effect of gender on bridging to transplantation and posttransplantation survival in patients with left ventricular assist devices. J Thorac Cardiovasc Surg. 2004;127:1193–5.

    Article  Google Scholar 

  12. Weymann A, Patil NP, Sabashnikov A, Mohite PN, Garcia Saez D, Amrani M, et al. Gender differences in continuous-flow left ventricular assist device therapy as a bridge to transplantation: a risk-adjusted comparison using a propensity score-matching analysis. Artif Organs. 2015;39:212–9.

    Article  CAS  Google Scholar 

  13. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53:982–92.

    Article  CAS  Google Scholar 

  14. Seguchi O, Kuroda K, Kumai Y, Nakajima S, Yanase M, Wada K, et al. Clinical outcomes of patients with the heartmate ii left ventricular assist device: a single-center experience from Japan. Transplant Proc. 2018;50:2726–32.

    Article  CAS  Google Scholar 

  15. INTERMACS Adverse Event Definitions: Adult and Pediatric patients. In; 2016. Accessed 13 Oct 2018.

  16. Fukushima N, Ono M, Saiki Y, Sawa Y, Nunoda S, Isobe M. Registry report on heart transplantation in Japan. Circ J. 2017;81:298–303.

    Article  Google Scholar 

  17. Fujita T, Kobayashi J, Hata H, Seguchi O, Murata Y, Yanase M, et al. Right heart failure and benefits of adjuvant tricuspid valve repair in patients undergoing left ventricular assist device implantation†. Eur J Cardiothorac Surg. 2014;46:802–7.

    Article  Google Scholar 

  18. Park SJ, Liao KK, Segurola R, Madhu KP, Miller LW. Management of aortic insufficiency in patients with left ventricular assist devices: a simple coaptation stitch method (Park’s stitch). J Thorac Cardiovasc Surg. 2010;127:264–6.

    Article  Google Scholar 

  19. Regitz-Zagrosek V, Petrov G, Lehmkuhl E, Smits JM, Babitsch B, Brunhuber C, et al. Heart transplantation in women with dilated cardiomyopathy. Transplantation. 2010;89:236–44.

    Article  Google Scholar 

  20. Matsumoto Y, Fujita T, Fukushima S, Hata H, Shimahara Y, Kume Y, et al. Comparison of hemodynamic performance and clinical results with EVAHEART versus heartmate II. ASAIO J. 2017;63:562–7.

    Article  Google Scholar 

  21. Yavar Z, Cowger JA, Moainie SL, Salerno CT, Ravichandran AK. Bleeding complication rates are higher in females after continuous-flow left ventricular assist device implantation. ASAIO J. 2018;64:748–53.

    Article  Google Scholar 

  22. Tsiouris A, Morgan JA, Nemeh HW, Hodari A, Brewer RJ, Paone G. Sex-specific outcomes in patients receiving continuous-flow left ventricular devices as a bridge to transplantation or destination therapy. ASAIO J. 2014;60:199–206.

    Article  Google Scholar 

  23. Grady KL, Wissman S, Naftel DC, Myer S, Gelijins A, Moskowitz A, et al. Age and gender differences and factors related to change in health-related quality of life from before to 6 months after LVAD implantation: findings from interagency registry for mechanically assisted circulatory support. J Heart Lung Transplant. 2016;35:777–88.

    Article  Google Scholar 

  24. Garrick CS, Micael MG. Mechanical circulatory support for advanced heart failure. Circulation. 2012;125:1304–15.

    Article  Google Scholar 

  25. Sidhu K, Lam PH, Mehra MR. Evolving trends in mechanical circulatory support: clinical development of a fully magnetically levitated durable ventricular assist device. Trends Cardiovasc Med. 2020;30:223–9.

    Article  Google Scholar 

  26. Maltais S, Kilic A, Nathan S, Keebler M, Emani S, Ransom J. PREVENtion of heartmate II pump thrombosis through clinical management: the PREVENT multi-center study. J Heart Lung Transplant. 2017;36:1–12.

    Article  Google Scholar 

  27. Kawabori M, Kurihara C, Sugiura T, Cohn WE, Civitello AB, Frazier OH, et al. Continuous-flow left ventricular assist device implantation in patients with a small left ventricle. Ann Thorac Surg. 2018;105:799–806.

    Article  Google Scholar 

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Acknowledgments

We thank Edanz Editing (www.edanzediting.com/ac), for editing a draft of this manuscript. We are grateful to Dr. Charles Jenkinson (St Vincent’s Hospital, Sydney) for English proofreading of this manuscript at the stage of revision.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan

    Yorihiko Matsumoto, Satsuki Fukushima, Yusuke Shimahara, Naoki Tadokoro, Takashi Kakuta, Junjiro Kobayashi & Tomoyuki Fujita

Authors
  1. Yorihiko Matsumoto
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  2. Satsuki Fukushima
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  3. Yusuke Shimahara
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  4. Naoki Tadokoro
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  5. Takashi Kakuta
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  6. Junjiro Kobayashi
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  7. Tomoyuki Fujita
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Correspondence to Tomoyuki Fujita.

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Matsumoto, Y., Fukushima, S., Shimahara, Y. et al. Sex differences in continuous-flow ventricular assist device therapy for advanced heart failure. Gen Thorac Cardiovasc Surg 69, 919–925 (2021). https://doi.org/10.1007/s11748-020-01538-5

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  • DOI: https://doi.org/10.1007/s11748-020-01538-5

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