| Heart failure continues to increase in incidence and prevalence. The lack of donor hearts relative to a growing number of potential transplant recipients as well as the population of heart failure patients for whom transplant is not an option has prompted increasing interest in the use of left ventricular assist devices (LVADs). While there is attention given in the literature specific to optimizing management of patients' co-morbidities, the appropriate selection of patients, and timing of LVAD implantation to achieve optimal clinical outcomes, there is a lack of attention directed toward timing of referral of patients to advanced heart failure centers for evaluation for potential LVAD implantation. The purpose of this project was to retrospectively examine some common diagnostic indicators obtained at the referral or initial encounter pre-operatively and evaluate relationships with post-implantation outcomes, to examine which of those may influence the optimal timing of such referrals. Pre-operative and post-implantation outcomes data was extracted from the medical records of 28 patients who received the Thoratec HeartMate IIRTM at the Virginia Commonwealth University Medical Center from May 2009 through December 2010 for treatment of late stage heart failure. Relationships between variables were evaluated using the Pearson's r correlation coefficient. Results were scrutinized to ascertain if any of the determinants examined might provide guidance for optimal timing of patient referrals to specialty centers. From this review, significant relationships were seen between renal function indicators at referral and in the early post-operative period, and a stronger relationship between those renal function indicators at pre-operative baseline and the early post-operative period. Impaired hepatic function bore a relationship to increased post-operative length of stay. In conclusion, while patients with preserved end-organ function have better outcomes in general, it is not possible to define referral and outcome relationships based on single determinants. Overall clinical indicators viewed as parts of each patient's entire presentation must be taken into account, and the value of trends across time prior to the advanced heart failure referral encounter could be potentially revealing as well. |
