Background:The impact of respiratory failure on patients undergoing left ventricular assist device (LVAD) implantation is not well understood, especially since these patients were excluded from landmark clinical trials. We sought to evaluate the associations between immediate preimplant and postimplant respiratory failure on outcomes in advanced heart failure patients undergoing LVAD implantation.Methods and Results:We included all patients in the Interagency Registry for Mechanically Assisted Circulatory Support who were implanted with continuous-flow LVADs from 2008 to 2016. Of the 16 362 patients who underwent continuous-flow LVAD placement, 906 (5.5%) required preimplant intubation within 48 hours before implantation, and 1001 (6.1%) patients developed respiratory failure within 1 week after implantation. A higher proportion of patients requiring preimplant intubation were Interagency Registry for Mechanically Assisted Circulatory Support profile 1, required mechanical circulatory support, and presented with cardiac arrest or myocardial infarction (P<0.001, all). At 1 year, 54.3% of patients intubated preimplant were alive without transplant, 20.1% had been transplanted, and 24.2% died before transplant. Patients requiring preimplant intubation had higher rates of postimplant complications, including bleeding, stroke, and right ventricular assist device implantation (P<0.01 for all). Among Interagency Registry for Mechanically Assisted Circulatory Support profile 1 patients, preimplant intubation incurred additional risk of death at 1 year compared with Interagency Registry for Mechanically Assisted Circulatory Support profile 1 patients not intubated (hazard ratio, 1.37 [95% CI, 1.13–1.65]; P=0.001). After multivariable analysis, both preimplant intubation (hazard ratio, 1.20 [95% CI, 1.03–1.41]; P=0.021) and respiratory failure within 1 week (hazard ratio, 2.54 [95% CI, 2.26–2.85]; P<0.001) were associated with higher all-cause 1-year mortality.Conclusions:Respiratory failure both before and after LVAD implantation identifies an advanced heart failure population with significantly worse 1-year mortality. This data might be helpful in counseling patients and their families about expectations about life with an LVAD.

中文翻译：

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接受持久性左心室辅助装置治疗末期心力衰竭的患者呼吸衰竭的临床意义。

背景：呼吸衰竭对接受左心室辅助装置（LVAD）植入的患者的影响尚不十分清楚，特别是因为这些患者被排除在具有里程碑意义的临床试验之外。我们试图评估在接受LVAD植入的晚期心力衰竭患者的即刻植入前和植入后呼吸衰竭与结局之间的关联。方法和结果：我们将所有接受机械辅助循环支持的机构间登记册中植入了持续性LVAD的患者纳入研究2008年至2016年。在16362例接受连续流LVAD植入的患者中，有906例（5.5％）在植入前48小时内需要进行植入前插管，而1001例（6.1％）患者在植入后1周内出现了呼吸衰竭。P <0.001，全部）。在1年时，有54.3％的经插管的植入前患者活着而没有进行移植，有20.1％的患者已经被移植，有24.2％的患者在移植前死亡。需要植入前插管的患者植入后并发症的发生率较高，包括出血，中风和右心室辅助装置植入（所有患者的P <0.01）。在机械辅助循环支持机构间登记处1例患者中，与未插管的机械辅助循环支持机构间登记处1例相比，植入前插管在1年时有额外的死亡风险（危险比，1.37 [95％CI，1.13-1.65] ；P = 0.001）。经过多变量分析后，均进行了植入前插管（风险比为1.20 [95％CI，1.03-1.41]；P= 0.021）和1周内的呼吸衰竭（危险比，2.54 [95％CI，2.26-2.85]；P <0.001）与较高的全因一年死亡率相关。结论：LVAD植入前后的呼吸衰竭。可以确定1年死亡率显着恶化的晚期心力衰竭人群。该数据可能有助于咨询患者及其家属对LVAD的预期生活。