LOW SERUM-CHOLESTEROL LEVELS PREDICT HIGH PERIOPERATIVE MORTALITY IN PATIENTS SUPPORTED BY A LEFT-VENTRICULAR ASSIST SYSTEM

Background: Although the use of a left-ventricular assist system (LVAS ) provides circulatory support for end-stage heart failure patients aw aiting heart transplantation, this procedure is accompanied by a relat ively high perioperative mortality. The aim of this retrospective stud y was to identify those patients preoperatively which have the highest perioperative mortality. Methods and Results: Forty-five consecutive patients undergoing LVAS implantation were evaluated for preoperative risk factors, including body mass index, hemodynamic data, and blood c hemistry studies by multivariate analysis. They were divided into (1) patients who were successfully transplanted (n = 25) and (2) patients who died before transplantation (n = 20). The nonsurvivors were subcla ssified into patients who died within 14 days after surgery (n = 11) a nd patients who died after 2 weeks of device implantation (n = 9). Hem odynamic parameters were the same in both groups, but total cholestero l was significantly lower in the nonsurvivors than in the survivors (9 0 +/- 7 vs. 144 +/- 8 mg/dl, respectively, p < 0.0001). The sensitivit y of predicting perioperative death with a serum cholesterol below 100 mg/dl was 100%, the specificity of predicting survival with a serum c holesterol above 120 mg/dl was 87%. Conclusion: In this small retrospe ctive study, there was a correlation between total cholesterol levels and survival of patients with advanced heart failure on mechanical sup port. A cholesterol level below 100 mg/dl was accompanied by a high pe rioperative mortality. In contrast, a cholesterol level above 120 mg/d l was accompanied by a 87% chance of survival. The results suggest a p redictive value of cholesterol which is independent of the hemodynamic status.