Purpose: The Minnesota Pectoralis Risk Score (MPRS) utilizes CT quantified thoracic muscle measures and clinical variables to predict survival after left ventricular assist device (LVAD) implantation. The model has not been assessed as a predictor of right ventricular failure (RVF) after LVAD.

Purpose: Published data on therapeutic plasma exchange (TPE) in patients with heparin induced thrombocytopenia (HIT) prior to left ventricular assist device (LVAD) implantation is limited. Here we describe a case series of patients with acute HIT who underwent TPE prior to LVAD implantation allowing the use of intraoperative heparin.

Purpose: Low thoracic muscle mass and tissue quantified on preoperative chest CTs are associated with increased post LVAD mortality. The serum sarcopenia index (SI), a ratio between serum creatinine and cystatin C, correlates with CT quantified muscle measurements in several disease states. The purpose of this analysis was to determine whether the SI itself is associated with post LVAD mortality.

Lactoferrin (LF) is a multifunctional antimicrobial, anti-inflammatory, and antioxidant protein that occurs naturally in mammals, most notably in exocrine gland tissues and fluids, such as in the eye. Nitrosative stress can promote changes to tyrosine and other amino acid residues of the protein, which also reduces the activity of LF. l-ergothioneine (ET) is a potent anti-inflammatory antioxidant present in the eye and other tissues through nutrition or supplementation and that may play a role in the prevention or treatment of a variety of diseases. Here we investigated the ability of ET to reduce 3-nitrotyrosine (NTyr) formation using two separate substrates, with the goal of determining whether ET can protect the antibacterial function of LF and other proteins when exposed separately to peroxynitrite and tetranitromethane as nitrating reagents. Native human LF was used as a simple protein substrate, and lamb corneal lysate was chosen as one example of mammalian tissue with a more complex mixture of proteins and other biomolecules. Nitration was monitored by absorbance and fluorescence spectroscopy as well as sandwich (nitrated LF) and direct NTyr (corneal lysate) enzyme-linked immunosorbent assays (ELISAs). We found that pretreatment with ET reduced chemical modification of both native LF and corneal lysate samples and loss of antibacterial LF function due to exposure to the nitrating reagents. These initial results suggest that ET, raised to sufficiently elevated levels, could be tailored as a therapeutic agent to reduce effects of nitrosative stress on LF and in turn sustain the protein activity.

Purpose Patients with a left ventricular assist device (LVAD) intended for bridge to transplant (BTT) are on longer duration of support while awaiting heart transplant (HT) in the updated UNOS allocation era. We sought to investigate the impact of LVAD support duration on pre-transplant recipient characteristics and selected post-HT variables. Methods Primary adult HT recipients (age ≥18 years) between January 1, 2005 and March 2, 2022 were identified from the Scientific Registry of Transplant Recipients (SRTR) database. Patients were separated into two groups: 1) controls with no mechanical circulatory support (MCS) bridging strategy, and 2) LVAD BTT. The LVAD BTT cohort was divided based on duration of pre-HT LVAD support: 1) 0-6 months; 2) 6-12 months; 3) 12-24 months; 4) 24+ months. Congenital and restrictive patients were excluded from all cohorts. Recipient characteristics and selected post-HT variables were compared between the groups. Results We identified a total of 14,780 non-MCS and 10,004 LVAD BTT patients with a median device duration of 11.8 months (Table). The following changes in recipient characteristics were noted with longer BTT LVAD support: 1) increasing BMI; 2) lower total bilirubin; 3) lower systolic PA pressure; 4) higher pre-transplant dialysis; and 5) lower inotrope requirements or being in the ICU at time of HT; all significant at a p<0.001 level. Recipients with longer BTT LVAD support had increased post-HT risk for: 1) stroke; 2) post-operative dialysis; and 3) length of hospital stay; all significant at p<0.001 level. Conclusion Although longer duration of BTT LVAD support may improve selected recipient characteristics, it is associated with increased post-HT hospital length of stay and complications. These data support ongoing efforts at modifying the current heart allocation policy. Allowing for higher acuity listing status based on the duration of LVAD support may further improve clinical outcomes in this population.

Purpose Correction of valvular pathology is often undertaken in patients undergoing LVAD implantation but impact on outcomes is uncertain. We compared clinical outcomes with HeartMate 3 (HM3) LVAD implantation in those with concurrent valve procedures (VP) to those with an isolated LVAD implant within the MOMENTUM3 trial portfolio, including the Pivotal Trial (n=515, NCT02224755) and Continued Access Protocol/ CAP (n=1685, NCT02892955). Methods The study included 2200 HM3 implanted patients. Among 820 concurrent procedures (including VP, CABG, RVAD, LAA closure), 466 (21.8%) were VPs (HM3+VP), including 81 aortic, 61 mitral, 163 tricuspid, and 85 patients with multiple VPs. Short and Long-term outcomes including peri-operative complications and healthcare resource use, major adverse events and survival were analyzed. Results Patients undergoing HM3+VP were older (63[54-70] vs. 62[52-68] yrs), with a sicker INTERMACS profile (1-2:41% vs.31%) and higher central venous pressure (11[8-16] vs. 9[6-14] mmHg) compared to HM3 alone (all p<0.05). The cardiopulmonary bypass time (124[97-158] vs.76[59-96] mins); ICU (8.5 [5-16] vs. 7 [5-13]) and hospital length of stay (20 [15-30] vs. 18 [14-24] days) were longer in HM3+VP (all p<0.0001). A significantly higher incidence of stroke (4.9% vs. 2.4%), bleeding (33.9% vs. 23.8%) and right heart failure (41.5% vs. 29.6%) was noted in HM3+VP for 0-30 days post-implant (all p<0.01), but 30-day survival was similar between groups (96.7% vs. 96.1%). There was no difference in 2-year survival in HM3+VP vs HM3 alone patients (HR[95%CI]:0.93 [0.71-1.21];p=0.60). Analysis of individual VPs showed no significant differences in survival compared to HM3 alone (Figure). Conclusion Concurrent VPs are commonly performed during LVAD implantation, are associated with increased morbidity during the index hospitalization, but short and long-term survival are not impacted adversely when compared with those that undergo an isolated LVAD procedure.

Purpose The HeartMate 3 left ventricular assist device (LVAD) has lower stroke rates compared to the HeartMate 2 in a clinical trial setting. Here we report real world stroke rates in patients implanted with HeartMate 2 and HeartMate 3 LVADs. Methods Data from a single center, first time continuous-flow LVAD cohort was utilized for this analysis (n=549). Patients with complete stroke data implanted with HeartMate2 (n=151) or HeartMate3(n=167) were included (n=318). Time to first stroke and stroke type were recorded. Freedom from all cause stroke by device type was estimated using the Kaplan Meir method and compared with the log rank test. To assess the adjusted difference in the rate of stroke by pump type, a multivariable cox regression was performed Results The mean age of the study cohort was 59 +/- 14 years, 83 % (265/318) were men, 63 % (197/318) were destination therapy and 31 % (97/318) were INTERMACS profiles 1 and 2. Freedom from all cause stroke to 1 year of LVAD support was similar between pumps (HeartMate 3: 88 % vs. HeartMate 2: 89 %, p = 0.76, adjusted HR 1.12, 95% CI 0.56-2.26, p=0.74), however the odds of thrombotic stroke in the first 60 days post-implantation was higher in the HeartMate 3 recipients (OR 2.5, 95 % CI 0 .86- 7.12, p=0.093). Ninety-five percent (17/18) of stroke events in HeartMate 3 recipients in the first 60 days post-implantation were ischemic in etiology. Conclusion The wider gaps within the HeartMate 3 may increase the risk of early post-operative embolic events. Special attention to prevent any material ingestion into the pump during HeartMate 3 implant is likely important and may reduce strokes in the early post-operative period.

Purpose Lactate dehydrogenase (LDH), a sensitive marker of hemolysis, is used to diagnose pump thrombosis in patients on left ventricular assist device (LVAD) support. Given the wider gaps for blood passage for the HeartMate 3 pump, LDH may not be as sensitive. We sought to define the expected ranges of D-dimer after HeartMate 3 implantation and to assess this as a biomarker of thrombotic events. Methods D-dimer and LDH were prospectively collected in a cohort of HeartMate 3 recipients (n=168) at both routine and non-routine clinic visits. Association between LDH and D-dimer was assessed in patients with these measurements occurring on the same day (repeated measures analysis, 707 measurements). Patients with outlier D-dimer values (higher than quartile 3 + 1.5 interquartile range) were investigated for a potential cause. Results The plot of D-dimer after HeartMate 3 implantation is displayed (Figure A). D-dimer is high initially and trends down over time, however, remains abnormal at all follow up time points (reference 0.0-0.5 ug/mL). D-dimer and LDH were positively correlated (repeated correlation coefficient 0.123, p=0.002, Figure B). Patients with outlier D-dimer values (n=11) did not have ischemic events (thrombosis or ischemic stroke) within 3 months of elevation, however 82% were associated with clinically meaningful events (33% suction, 33% gaps in anticoagulation, 22% cancer, and 22% infection). Conclusion Median D-dimer remains abnormal at all time points on HeartMate 3 support. LDH and D-dimer are positively correlated. While D-dimer did not correlate with thrombotic events, significant elevations in D-dimer were associated with clinically meaningful events.

Introduction The optimal surgical technique for HVAD to HeartMate 3 left ventricular assist device (LVAD) exchange will be patient dependent. We report a successful minimally invasive approach. Case Report Case: A 33-year-old woman with Adriamycin induced cardiomyopathy status post destination therapy HVAD in 2006 developed progressive alarms. Imaging revealed a large left ventricular (LV) thrombus attached to the inflow cannula. An elective HVAD to HeartMate 3 exchange was considered. Pre-operative planning: CT imaging was used to generate a three dimensional (3D) model of the heart and HVAD (A). To aid in planning both new device placement and the anastomosis between the HVAD and HeartMate 3 outflow grafts, a 3D model was generated (B). Surgical description: A left thoracotomy and 5th rib resection was used to access the HVAD and LV apex (C). The femoral vessels were cannulated for cardiopulmonary bypass and the heart was minimally manipulated. The HVAD pump, apical cuff, and exposed driveline were removed and LV clot evacuated. The HeartMate 3 apical cuff was secured to the LV apex and the pump placed in standard position (D). The HeartMate 3 (14mm) outflow graft was anastomosed to the retained HVAD (10mm) outflow graft by beveling the HVAD outflow graft (E, F). The HeartMate 3 driveline was then tunneled out of the left upper abdominal quadrant using a double tunnel technique. The thoracotomy was then closed in a standard fashion. Summary Outcome: The total bypass time was 1 hour and 20 minutes. She arrived to the intensive care unit on low dose epinephrine and vasopressin, which were rapidly weaned off. She required a total of 2 packed red blood cell transfusions. She was extubated on post-operative day 3 with normal hemodynamics and intact end organ function. She was eventually discharged in stable condition. 3D modeling was invaluable in preprocedural planning and final outcomes.

Purpose Bloodstream infection (BSI) is a severe complication in patients with continuous flow left ventricular assist devices (CF-LVADs). In this study, we aimed to describe the incidence of BSI on contemporary LVAD support and its impact on subsequent survival. Methods This analysis included adult patients with first time CF LVAD implantation at a single center (June 2005-June 2020). BSI was defined as ≥1 positive blood culture with a likely pathogen (e.g. Staphylococcus aureus) or >1 positive blood culture with a low virulence skin organism (e.g. Staphylococcus epidermidis). Time to BSI was recorded for each patient. Survival-free of BSI was estimated using Kaplan-Meier method and compared among device types. Survival among patients who did and did not develop BSI by 9 months post implant was compared using Cox regression adjusting for medical and social factors. Results 502 patients were included in the analysis. Over a median follow up period of 1,468 days (IQR 454-3,081 days), 73 (14.5%) developed a BSI. Patients who developed BSI were more likely to have diabetes, implanted cardiac defibrillators, and to have a designation of destination therapy. Median time to BSI was 389 days (IQR 94-997). The most common organisms were enterococci (23%) and streptococci (23%). At the time of BSI, 53% of patients had a WBC count above 11 × 109/L. Compared to the HeartMate 2, patients implanted with the HeartMate 3 had a lower rate of 1-year survival free of BSI (87% vs. 95 %, p=0.007). When comparing survival after 9 months among those with and without BSI, mortality was significantly higher in patients with BSI in both unadjusted (HR =1.96, 95% CI; 1.02 - 3.76) and adjusted models (2.00, 95% CI; 1.03 - 3.88). Conclusion BSI continues to occur in the contemporary era of LVAD therapy and is associated with significantly worse survival. The absence of elevated WBC count in LVAD patients with severe infections such as bacteremia raises the question of whether leukocytosis should be infection criteria for UNOS status increase.

Purpose To assess for a post left ventricular assist device (LVAD) hemodynamic profile predictive of early mortality. Methods A single center first-time, continuous-flow LVAD dataset was utilized for this analysis (n=505). Vasoactive drips and hemodynamics were collected at the following time points in all subjects with available data: pre-op, immediate post-op, and on post-operative days 1, 2, and 3 (n=325). Vasoactive intropes scores (VIS) were calculated at each time point. Trends before and after LVAD were computed and plotted using Locally Estimated Scatterplot Smoothing (LOESS), stratfied by death at 60 days post LVAD implantation. Mutivariate logistic regression and reciever operator curve analyses were performed to test the association between candidate variables and death at 60 days. Results The distinctive hemodynamic feature of patients who experienced death by 60 days was a failure to increase mean arterial pressure (MAP) from the time of leaving the operating room to post-operative day two accompanied by persistently elevated VIS (Figure). A model incorporating post-operative day two VIS, mean arterial pressure and right atrial pressure had an AUC of 78% to predict 60-day death. The group experiencing early mortality had higher measured cardiac indices, lower systemic vascular resistance, and higher right atrial pressures than patients who survived past 60 days, suggesting overlap between classic right ventricular failure and vasoplegia physiology. In this dataset, half of patients who met the criteria for vasoplegia also met criteria for right ventricular failure (21/41, 51%). Conclusion The failure to increase mean arterial pressure accompanied by high doses of inotropic and vasopressor support early after LVAD is highly associated with early mortality. This hemodynamic profile may be more unifying than existing right heart failure and vasoplegia definitions, which appear to have significant overlap. These findings require validation in an external dataset.

Purpose Measured glomerular filtration rate (GFR) improves initially after left ventricular assist device (LVAD) implantation and then declines. The reasons for this decline are incompletely understood. We hypothesize that the decline in measured GFR after LVAD is associated with the timing of increasing body mass after surgery. Methods Patients with a first time continuous-flow LVAD implant at a single center with renal function data and body mass index (BMI) data before and after LVAD were included in the analysis (n=410). GFR at each time point was calculated with CKD-EPI equation. Trends before and after LVAD were computed and plotted using Locally Estimated Scatterplot Smoothing (LOESS). Linear mixed effects modeling was performed to test the association between GFR and BMI accounting for correlated, repeated measures within persons. Results Plots of GFR and BMI before and after LVAD implantation are displayed (Figure). BMI decreased prior to LVAD, decreased further after LVAD, and then steadily increased. GFR declined in the cohort prior to LVAD, improved with medical optimization, improved further post LVAD, and then declined again. Across the cohort there was a strong association between GFR and BMI (p<.001). Each 0.5 unit increase in BMI was associated with a 2.7 unit decrease in GFR. Conclusion The displayed trends suggest GFR is over-estimated in the late stages of heart failure and in the immediate post LVAD period due to low creatinine production from sarcopenia. Use of creatinine in the advanced heart failure population may lead to inaccurate GFR estimates. This has broad implications for treatment of the heart failure population.

In addition to SARS-CoV-2 and its variants, emerging viruses that cause respiratory viral infections will continue to arise. Increasing evidence suggests a delayed, possibly suppressed, type 1 interferon (IFN-I) response occurs early during COVID-19 and other viral respiratory infections such as SARS and MERS. These observations prompt considering IFN-β as a prophylactic or early intervention for respiratory viral infections. A rationale for developing and testing intranasal interferon beta (IFN-β) as an immediately available intervention for new respiratory viral infections that will arise unexpectedly in the future is presented and supported by basic and clinical trial observations. IFN-β prophylaxis could limit the spread and consequences of an emerging respiratory viral infection in at-risk individuals while specific vaccines are being developed.

Purpose To test the hypothesis that advanced heart failure patients lose weight prior to LVAD, gain weight after LVAD, and that weight loss prior to LVAD is associated with lower pectroralis muscle measures (PMM) quantified on pre operative chest CT scans. Methods The larger cohort for the BMI trend analysis included patients with first-time LVAD implantation at a single center (n=505). The following PMMs were quantified in patients with chest CTs performed within 3 months prior to LVAD implantation (n=194): pectoralis muscle mass indexed to height in meters squared (PMI) and mean Hounsfield units (PHUm). BMI trends before and after LVAD were computed and plotted using Locally Estimated Scatterplot Smoothing (LOESS). BMI prior to LVAD was then regressed longitudinally. The association between BMI trend and PMMs were assessed by including fixed effects for time, PMMs, and their interactions. Results BMI plots are displayed (Figure). For the entire cohort, BMI decreased prior to LVAD, continued to decrease further after LVAD, and then steadily increased. Across PMM tertiles, the same pattern was observed. At 100 days prior to LVAD, both PMMs were significantly associated with BMI (p <0.05). The trend of BMI prior to LVAD was signficantly associated with PHUm (p<0.05), with a more severe decline in BMI being associated with lower tissue attenuation (PHUm). Conclusion The trend in BMI across the larger cohort before and after LVAD suggests that LVAD recipients are largely sarcopenic at the time of LVAD. The correlation between more rapid weight loss and lower PMMs supports this hypothesis. As muscle wasting is progressive, and lower PMMs are assoiciated with increased post-LVAD mortality, there may be a role in utilizing PMMs to determining optimal implantation timing.

Purpose To describe adverse events associated with subclavian access intra-aortic balloon pump (IABP) before and after cardiac transplant utilizing high level, single center data. In order to assess morbidity associated with IABP use, a matched United Network for Organ Sharing (UNOS) cohort without IABP support was created as a comparison group. Methods The study included two patient groups: 1) patients bridged to cardiac transplant as Status 2 with subclavian access IABP at single center and 2) a UNOS cohort of transplant recipients (between 2014-2018) matched on hemodynamic Status 2 requirements and wait times. Patient characteristics and post-transplant outcomes were compared. Complications specific to the subclavian IABP using the single center data were collected and reported. Results The single center subclavian access IABP cohort included 28 patients and was compared to the matched UNOS cohort of 202 patients. There was no significant difference in age, ischemic cardiomyopathy diagnosis, or wait times between the two cohorts (Table 1). Post-transplant length of stay and need for post-transplant dialysis was higher in the IABP supported patients. The one-year survival probabilities were similar (subclavian IABP: 96%, matched UNOS cohort: 93%, log rank p = 0.97). Balloon pump repositioning (36%) and replacement (21%) were common. Post-operative infections attributable to the graft site occurred in 17% of patients. Conclusion Patients transplanted on subclavian access IABP had comparable survival at 1 year to a UNOS matched cohort, however IABP re-positioning, replacement and post-operative infections were common. The matched cohort analysis suggests the IABP itself may be associated with longer length of stay and higher rates of post-transplant dialysis, although patient acuity may have accounted for this difference despite hemodynamic matching.

PurposeTo model renal function in an advanced heart failure population both prior to and after left ventricular assist device (LVAD) and to determine the association between pre-operative renal function trends and post-LVAD mortality.MethodsPatients with a first time continuous-flow LVAD implant at a single center with renal function data before and after LVAD were included in the analysis (n=410). GFR at each time point was calculated with the CKD-EPI equation. Trends before and after LVAD were computed and plotted using Locally Estimated Scatterplot Smoothing (LOESS). GFR between 200 to 100 days prior to LVAD was regressed longitudinally to calculate a slope of GFR change prior to LVAD. Both the GFR slope and nadir of GFR prior to LVAD (Figure) were assessed as predictors of post LVAD mortality using multivariable cox regression.ResultsWhen assessed as a whole, GFR declined in the entire cohort prior to LVAD, improved with medical optimization, improved further post LVAD, and then declined again to a level that was similar to initially measured values. Each unit decrease in the GFR slope was associated with an adjusted 35% increase in post LVAD mortality (HR 1.36, 95% CI 1.15-1.51, p=0.002). With respect to the GFR nadir, each 10-unit decrease was associated with an adjusted 19% increase in post-LVAD mortality (HR 1.19, 95% CI 1.07- 1.30, p = 0.003). Models were adjusted for age, bridge to transplant status, ischemic cardiomyopathy, and diabetes.ConclusionThis analysis demonstrates that renal function in the advanced heart failure population prior to LVAD is complex, with declines in renal function prior to LVAD, and the nadir of GFR prior to LVAD being associated with increased post LVAD mortality. This data suggest earlier LVAD placement prior to measurable renal deterioration may be beneficial. To model renal function in an advanced heart failure population both prior to and after left ventricular assist device (LVAD) and to determine the association between pre-operative renal function trends and post-LVAD mortality. Patients with a first time continuous-flow LVAD implant at a single center with renal function data before and after LVAD were included in the analysis (n=410). GFR at each time point was calculated with the CKD-EPI equation. Trends before and after LVAD were computed and plotted using Locally Estimated Scatterplot Smoothing (LOESS). GFR between 200 to 100 days prior to LVAD was regressed longitudinally to calculate a slope of GFR change prior to LVAD. Both the GFR slope and nadir of GFR prior to LVAD (Figure) were assessed as predictors of post LVAD mortality using multivariable cox regression. When assessed as a whole, GFR declined in the entire cohort prior to LVAD, improved with medical optimization, improved further post LVAD, and then declined again to a level that was similar to initially measured values. Each unit decrease in the GFR slope was associated with an adjusted 35% increase in post LVAD mortality (HR 1.36, 95% CI 1.15-1.51, p=0.002). With respect to the GFR nadir, each 10-unit decrease was associated with an adjusted 19% increase in post-LVAD mortality (HR 1.19, 95% CI 1.07- 1.30, p = 0.003). Models were adjusted for age, bridge to transplant status, ischemic cardiomyopathy, and diabetes. This analysis demonstrates that renal function in the advanced heart failure population prior to LVAD is complex, with declines in renal function prior to LVAD, and the nadir of GFR prior to LVAD being associated with increased post LVAD mortality. This data suggest earlier LVAD placement prior to measurable renal deterioration may be beneficial.

PurposeTo assess the performance of several post cardiac surgery vasoplegia definitions in a large, single center continuous-flow left ventricular assist device (CF-LVAD) cohort.MethodsA single center first-time, CF-LVAD dataset was utilized for this analysis (n=505). Vasoactive drips and hemodynamics were collected at the following time points in all subjects with available data: pre-op, immediate post-op, and on post-operative days 1, 2, and 3 (n=325). For each of the four vasoplegia definitions tested (table), infusion requirements for each definition were converted to an equivalent vasoactive intropes score (VIS). VIS were then cacluated for each patient, at each time point, and utilzied to determine if vasoplegia criteria were met. To test the assoication between vasoplegia and post LVAD mortality, logistic regression (60-day death as outcome) and cox regression analyses were performed. To assess for clinical predictors of post-opertive vasoplegia, a mutivariable logisitic regression was performed.ResultsAmong the vasoplegia definitions tested, the Patarroyo definition had the strongest association with death at 60 days (OR 3.55, 95 % CI 1.48-8.52, p=0.005). This defintion was met by 14% of cohort subjects with available data. Variables associated with the development of vasoplegia using this definition in the mutivariate models inlcuded higher creatinine, longer cardiopulmonary bypass time, prior cardiothoracic sugery and lower INTERMACS profile. Two of the vasoplegia definitions tested (Levin, Unified) had little utility to classify vasoplegia due to the requirement for mean arterial pressure to be less than 50 mm Hg.ConclusionAmong the post-cardiothoracic surgery vasoplegia definitions tested, the Patrroyo was the most highly associated with early post LVAD mortality in this dataset. Risk factors for vasoplegia were similar to previous published reports. Use of VIS simplified the process of determining vasoplegia infusion. criteria To assess the performance of several post cardiac surgery vasoplegia definitions in a large, single center continuous-flow left ventricular assist device (CF-LVAD) cohort. A single center first-time, CF-LVAD dataset was utilized for this analysis (n=505). Vasoactive drips and hemodynamics were collected at the following time points in all subjects with available data: pre-op, immediate post-op, and on post-operative days 1, 2, and 3 (n=325). For each of the four vasoplegia definitions tested (table), infusion requirements for each definition were converted to an equivalent vasoactive intropes score (VIS). VIS were then cacluated for each patient, at each time point, and utilzied to determine if vasoplegia criteria were met. To test the assoication between vasoplegia and post LVAD mortality, logistic regression (60-day death as outcome) and cox regression analyses were performed. To assess for clinical predictors of post-opertive vasoplegia, a mutivariable logisitic regression was performed. Among the vasoplegia definitions tested, the Patarroyo definition had the strongest association with death at 60 days (OR 3.55, 95 % CI 1.48-8.52, p=0.005). This defintion was met by 14% of cohort subjects with available data. Variables associated with the development of vasoplegia using this definition in the mutivariate models inlcuded higher creatinine, longer cardiopulmonary bypass time, prior cardiothoracic sugery and lower INTERMACS profile. Two of the vasoplegia definitions tested (Levin, Unified) had little utility to classify vasoplegia due to the requirement for mean arterial pressure to be less than 50 mm Hg. Among the post-cardiothoracic surgery vasoplegia definitions tested, the Patrroyo was the most highly associated with early post LVAD mortality in this dataset. Risk factors for vasoplegia were similar to previous published reports. Use of VIS simplified the process of determining vasoplegia infusion. criteria