Associations Between Pre-Implant Cancer and Left Ventricular Assist Device Outcomes: An Intermacs Registry Analysis

Document Type

Conference Proceeding

Publication Date

4-1-2023

Publication Title

J Heart Lung Transplant

Abstract

Purpose: Few studies have examined the effect of pre-implant cancer history on clinical outcomes in patients with left ventricular assist devices (LVAD). We used the INTERMACS registry to compare rates of post-LVAD adverse outcomes in patients with and without a history of a solid tumor or hematologic malignancy.

Methods: We included LVAD recipients in the INTERMACS registry from 2007-2017 who had their cancer history reported (N=18053, age: 56.4 years, 22% female, 24% Black). Cox proportional hazard models were used to examine the association between pre-implant cancer and outcomes of all-cause mortality, major bleeding events, major infection events, stroke/transient ischemic attack (TIA), renal dysfunction, pump thrombosis, and heart transplantation. Logistic regression modeling was used to examine the association between pre-implant cancer and right ventricular failure (RVF). Multivariable models were adjusted for clinically relevant covariates.

Results: A total of 1124 (6.2%) patients had a history of cancer, with 894 (5.0%) patients having solid tumors and 259 (1.4%) patients having hematologic malignancies. History of solid tumors was associated with increased risk of mortality, bleeding events, pump thrombosis, and decreased likelihood of transplantation compared to non-cancer patients on multivariable analyses (Table). History of hematologic malignancies was associated with an increased risk of major infection, RVF, and renal dysfunction compared with non-cancer patients on multivariable analyses. There were no significant associations between either cancer type and stroke/TIA after adjustment for covariates.

Conclusion: The risk for post-LVAD complications differs based on cancer type. As survival in cancer patients improves and LVADs are increasingly used in this population, more data that will help in the prediction and management of post-LVAD complications is critical.

Volume

42

Issue

4

First Page

S136

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