Introduction: Different factors are associated with a poor outcome after left ventricular assist device (LVAD) implantation, the most common being right ventricular (RV) dysfunction, hemorrhage and infections. While many studies evaluate hemodynamic parameters relating to RV function, sparse research focuses on other parameters as potential predictors of worse outcome. We analysed the outcomes of patients that underwent LVAD implantation to determine the main causes of mortality and detect the predictors associated with this outcome.

Patients and Methods: We studied 31 patients (27 male, mean age 57.8±14.1 y) with LVADs over a median follow-up period of 11 months. Patient history, INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) score, pre- and postimplantation laboratory results, echocardiography and right heart catheterization data were collected and analysed according to overall survival.

Results: Overall, 14 patients (45%) died, mostly due to bleeding complications (5/14), followed by postoperative infections (3/14). All patients had an INTERMACS score 4 or lower, and there was no significant difference between the survival groups according to the analysed hemodynamic parameters. RV function was on average borderline (FAC 26.5±11.8%, TAPSE 1.4±0.4 cm), the cardiac index was low (1.7±0.6 L/min/m2), transpulmonary pressure gradient was slightly (14±8 mmHg) and the pulmonary vascular resistance was moderately elevated (4.1±2.6 WU). The survival groups did not differ in most of the laboratory findings, but the expired patients had a significantly lower preoperative platelet count (Plt) (185±62 vs. 241±70 x10E9/L, p=0.04). The threshold value of Plt set at 170x10E9/L defined an increased hazard ratio for the patients with higher Plts (HR 3.04, C.I. 1.02-9.15; Figure 1). Notably, patients with lower Plts had also a significantly lower preoperative hemoglobin levels (109±22 vs 137±26 g/L, p=0.02).

Conclusion: Rigorous evaluation of hemodynamic parameters is essential in the optimal selection of LVAD candidates, while preoperative platelet count could be a potential predictor of postoperative hemorrhagic diathesis.