Vascular complications associated with percutaneous left ventricular assist device placement: A 10‐year US perspective

Abstract

Abstract Background Over the last decade, there has been a significant increase in the use of percutaneous left ventricular assist devices(p‐LVADs). p‐LVADs are being increasingly used during complex coronary interventions and for acute cardiogenic shock. These large bore percutaneous devices have a higher risk of vascular complications. We examined the vascular complication rates from the use of p‐LVAD in a national database. Methods We conducted a secondary analysis of the National In‐patient Sample (NIS) dataset from 2005 till 2015. We used the ICD‐9‐CM procedure codes 37.68 and 37.62 for p‐LVAD placement regardless of indications. We investigated common vascular complications, defining them by the validated ICD 9 CM codes. χ 2 test and t test were used for categorical and continuous variables, respectively for comparison. Results A total of 31,263 p‐LVAD placements were identified during the period studied. A majority of patients were male (72.68%) and 64.44% were white. The overall incidence of vascular complications was 13.53%, out of which 56% required surgical treatment. Acute limb thromboembolism and bleeding requiring transfusion accounted for 27.6% and 21.8% of all vascular complications. Occurrence of a vascular complication was associated with significantly higher in‐hospital mortality (37.77% vs. 29.95%, p < .001), length of stay (22.7 vs. 12.2 days, p < .001) and cost of hospitalization ($ 161,923 vs. $ 95,547, p < .001). Conclusions There is a high incidence of vascular complications with p‐LVAD placement including need for vascular surgery. These complications are associated with a higher in‐hospital, LOS and hospitalization costs. These findings should be factored into the decision‐making for p‐LVAD placement.