Clinical predictors of major adverse cardiovascular events in patients with left ventricular assist devices: a systematic review and meta-analysis

Abstract Background Durable left ventricular assist devices (LVAD) are a vital therapeutic modality in the setting of refractory advanced heart (HF) and limited availability of cardiac transplantation. Major adverse cardiovascular events (MACE) post LVAD implantation are complications associated with increased morbidity and mortality thereby resulting in longer hospital admissions. The aim of our systematic review and meta-analysis was to evaluate pre-implantation clinical, biochemical and device-specific factors that were associated with MACE, including ventricular arrhythmias, right heart failure, stroke and need for ischemic revascularisation, in patients post-LVAD implantation. Methodology A comprehensive literature search of medical databases (PubMed, Cochrane, Medline, Embase, BMJ) and grey literature was conducted. Studies were included if they reported MACE and other pre-implantation clinical, biochemical and device-specific parameters in patients post durable LVAD insertion (2000-2025; English Only). Data for all variables were extracted and those with low heterogeneity were then meta-analysed using a random-effect model for odds ratios (OR) or standardised mean differences (SMD). Results Out of a total of 1710 studies that were screened, 48 peer-reviewed articles fulfilled criteria for inclusion. A total of 9532 patients were included in the meta-analysis, with 35 factors assessed. Our meta-analysis identified that predictors of MACE in patients post-LVAD included clinical variables: intra-aortic balloon pump (OR 1.291, p=0.048), extracorporeal membrane oxygenation (OR 1.568, p=0.049), ventilator support (OR 1.882, p=0.003), existing implantable cardioverter-defibrillator (OR 1.518, p0.001), use of anti-arrhythmic drugs (OR 1.768, p0.001), previous cerebrovascular accident (OR 1.648, p=0.016), previous ventricular arrhythmia (OR 2.420, p0.001); biochemical variables: creatinine (SMD 0.250, p0.001) and bilirubin (SMD 0.263, p=0.007); device-specific variables: destination therapy (OR 1.176, p=0.049). Conclusions The findings of our meta-analysis highlight several key prognostic pre-implantation factors that appear to be associated with increased MACE post-LVAD implantation, which may be utilised in clinical decision-making regarding patient eligibility, suitability and prognosis for mechanical cardiac assist device therapy.PRISMA Flow Diagram Summary Table of Meta-Analysis Findings