Sex-Specific Outcomes in Patients Receiving Continuous-Flow Left Ventricular Devices as a Bridge to Transplantation or Destination Therapy

• Type of Material: Article
• Authors: Athanasios Tsiouris, Henry Ford Hospital; Jeffrey A. Morgan, Henry Ford Hospital; Hassan W. Nemeh, Henry Ford Hospital; Arielle Hodari, Henry Ford Hospital; Robert J. Brewer, Henry Ford Hospital; Gaetano Paone, Emory University
• Language: English
• Date: 2014-03-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Final Published Version
• Copyright Statement: © 2014 by the American Society for Artificial Internal Organs
• License: Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.1097/MAT.0000000000000048
• Title of Journal or Parent Work: ASAIO JOURNAL
• Volume: 60
• Issue: 2
• Start Page: 199
• End Page: 206
• Keywords: MORTALITY; Technology; gender; Transplantation; GENDER-RELATED DIFFERENCES; left ventricular assist device; outcomes; MECHANICAL CIRCULATORY SUPPORT; Science & Technology; CONGESTIVE-HEART-FAILURE; Life Sciences & Biomedicine; Engineering, Biomedical; TERM OUTCOMES; ARTERY; male; ASSIST DEVICE; female; Engineering; sex; IMPLANTATION; SURGERY; LVAD; SURVIVAL
• Research Categories: Biology, Anatomy; Health Sciences, Medicine and Surgery; Gender Studies

Abstract

Reports on sex-related outcomes in left ventricular assist device (LVAD) patients are conflicting. In addition, females have been underrepresented in most multicenter randomized controlled trials for mechanical circulatory support (MCS). The objective of our study was to analyze our experience implanting 130 continuous-flow LVADs and to determine the impact of sex on survival. We identified 130 patients who underwent implantation of a continuous-flow LVAD at our institution. Patients were stratified into two groups based on sex. Variables were compared using two-sided t-tests, χ tests, Cox proportional hazards models, and log-rank tests to determine whether there was a difference between the two groups and if sex was a significant independent predictor of outcome. Of the 130 patients, 35 were females and 95 were males. Female patients had worse pre-LVAD cardiac output and cardiac index and were more likely to be on MCS at the time of implantation. Male patients had worse renal function. Survival was analogous for both cohorts with 30 day, 6 month, 1 year, and 2 year survivals of 97%, 90.8%, 90.8%, and 84.3%, respectively, for female patients versus 94.7%, 87.9%, 78.4%, and 72.8%, respectively, for male patients. The incidence of other LVAD-related complications was also similar in both groups. Gender did not predict postoperative mortality on univariate analysis. Contrary to most published reports, female and male LVAD patients have similar postoperative and midterm survival, length of hospital stay, readmission rates, and postoperative complications. It appears that females have gained more benefit from newer generation devices compared to males.