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Comparative Study
. 2018 Aug;106(2):555-560.
doi: 10.1016/j.athoracsur.2018.02.045. Epub 2018 Mar 22.

Influence of Diabetes Mellitus on Outcomes in Patients After Left Ventricular Assist Device Implantation

Chinenye O Usoh  1 , Saadia Sherazi  2 , Barbara Szepietowska  2 , Valentina Kutyifa  2 , Scott McNitt  2 , Anna Papernov  2 , Meng Wang  2 , Jeffrey D Alexis  3
Affiliations
Comparative Study

Influence of Diabetes Mellitus on Outcomes in Patients After Left Ventricular Assist Device Implantation

Chinenye O Usoh et al. Ann Thorac Surg. 2018 Aug.

Abstract

Background: Despite previous studies, the mortality risk of patients with diabetes mellitus after left ventricular assist device (LVAD) implant remains unclear. In addition, the relationship between the degree of glycemic control and long-term mortality risk in LVAD patients with diabetes has not been established.

Methods: Ninety-five nondiabetic patients and 96 diabetic patients from the University of Rochester Medical Center who received a HeartMate II (Thoratec, Pleasanton, CA) continuous-flow LVAD between May 2008 and June 2014 were included in this study. The primary outcome was all-cause mortality. Secondary outcomes included rates of infection, neurologic dysfunction, renal dysfunction, and rehospitalization. Kaplan-Meier survival analyses and Cox models were utilized.

Results: During follow-up, 32 diabetic patients (33%) and 15 nondiabetic patients (16%) died after LVAD implantation. Cumulative probability of death was higher for diabetic patients when compared with nondiabetic patients (42% versus 21% at 3 years, p = 0.013). There were no significant differences in overall rates of infection, neurologic dysfunction, and rehospitalization between the two groups. However, after an initial secondary outcome event, diabetic patients continued to have a higher mortality rate when compared with nondiabetic patients. There was no statistically significant difference in the risk of death between diabetic patients with pre-LVAD hemoglobin A1c less than 7.0% and diabetic patients with pre-LVAD hemoglobin A1c 7.0% or greater (hazard ratio 1.71, 95% confidence interval: 0.72 to 4.08, p = 0.223).

Conclusions: Diabetic patients who underwent LVAD implantation had a higher risk of death compared with nondiabetic patients. Adverse event rates did not differ between the two groups. Finally, the degree of glycemic control in diabetic patients before LVAD was not found to influence mortality.

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Figures

Figure 1
Figure 1
Probability of death in diabetics and non-diabetics after LVAD implant.
Figure 2
Figure 2
Probability of death after initial outcome. (A) Probability of death after initial infection. (B) Probability of death after initial neurological insult. (C) Probability of death after initial re-hospitalization.
Figure 2
Figure 2
Probability of death after initial outcome. (A) Probability of death after initial infection. (B) Probability of death after initial neurological insult. (C) Probability of death after initial re-hospitalization.
Figure 2
Figure 2
Probability of death after initial outcome. (A) Probability of death after initial infection. (B) Probability of death after initial neurological insult. (C) Probability of death after initial re-hospitalization.
Figure 3
Figure 3
Probability of death according to pre-LVAD glycemic control among diabetics.
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