In-hospital bowel ischemia and mortality trends of left ventricular assist device placement in the USA from 2017 to 2020

Abstract Background Left ventricular assist devices (LVADs) are critical for treating advanced heart failure patients. Yet, insights into clinical outcomes, particularly concerning bowel ischemia and mortality, remain scarce. Purpose We aimed to examine temporal trends of in-hospital mortality and bowel ischemia among heart failure patients with LVAD between 2017 and 2020. Methods The National Inpatient Sample was queried from 2017 to 2020 to identify all adults with congestive heart failure who underwent LVAD implantation using the International Classification of Diseases 10th Revision codes. The Cochran-Armitage test was used to assess the linear trend of in-hospital bowel ischemia with LVAD. Multivariable regression analysis was conducted to evaluate the association of LVAD placement with in-hospital mortality and bowel ischemia. The Elixhauser comorbidity index was used to adjust for confounders. Linear logistic results are represented as adjusted odds ratios (ORs) with their respective 95% Confidence Intervals (CIs). Results Of a total of 19,410 LVAD placements, 189 (0.97%) patients developed bowel ischemia of any type. The mean age of these patients was 58 years, with a predominance of males (68%). A trend analysis revealed an increasing occurrence of bowel ischemia following LVAD placement over the years (trend: 1%, p < 0.001). Specifically, the proportion of LVAD patients with bowel ischemia was 0.8% in 2017 (OR = 6, 95% CI 3.6-13, p < 0.001), increased slightly to 0.9% in 2018 (OR = 6.2, 95% CI 3.4-11.7, p < 0.001), followed by a decrease to 0.73% in 2019 (OR = 4.2, 95% CI 2.4-7.5, p = 0.02), and then a rise to 1.53% in 2020 (OR = 7.2, 95% CI 4-12.9, p < 0.001), as illustrated in Figure 1. Across all years, LVAD placement was associated with a significant risk for developing bowel ischemia (OR= 6.9, 95% CI 5-9.6, p < 0.001).The mortality rate among patients who developed bowel ischemia post-LVAD insertion was significant, with a rate of 50% in 2017 (OR = 5.3, 95% CI 1.3-20, p = 0.01), escalating to 67% in 2018 (OR = 10, 95% CI 2.4-43, p < 0.002), and stabilizing at 57% for both 2019 (OR = 8, 95% CI 1.8-37.3, p < 0.006) and 2020 (OR = 6.7, 95% CI 2.3-19.1, p < 0.001), as detailed in Table 1. The overall in-hospital mortality for patients with LVAD and bowel ischemia was 58% (OR = 7, 95% CI 4-14, p < 0.001). Conclusions The study indicates rising trends in-hospital bowel ischemia and fluctuations in mortality rates in LVAD patients from 2017 to 2020. Despite its rarity, LVAD placement carries a notable risk of bowel ischemia, which significantly affects mortality. This underscores the need for vigilant monitoring and management.Figure 1Table 1