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Background: The predictive value of preoperative pulmonary function testing (PFT) in left ventricular assist device (LVAD) patients remains unknown. This study evaluates the relationship between abnormal PFTs and postimplant outcomes in LVAD patients. Methods: LVAD implants from January 2004 to December 2018 at a single institution were included. Patients were stratified based on the presence of abnormal preoperative PFTs, and the primary outcome was respiratory adverse events (AE). Secondary outcomes included 1‐year overall postimplant survival, and complications including bleeding, renal failure, thromboembolism, and device malfunction. Results: The total of 333 patients underwent LVAD implant, 46.5% (n = 155) with normal PFTs and 53.5% (n = 178) with abnormal PFTs. Patients with abnormal PFTs were noted to have higher rates of respiratory AEs (25.9% vs. 15.1%, p =.049). In multivariable analysis, the impact of PFTs was most significant when forced expiratory volume in 1 s/forced expiratory volume (FEV1/FVC) ratio was less than 0.5 (hazard ratio [HR] 16.32, 95% confidence interval [CI], 1.70–156.78). The rates of other AEs including bleeding, renal failure, right heart failure, and device malfunction were similar. One‐year overall postimplant survival was comparable between the groups (56.8% vs. 68.8%, p =.3183), though patients in the lowest strata of FEV1 (<60% predicted) and FEV1/FVC (<0.5) had elevated risk‐adjusted hazards for mortality (HR 2.63, 95% CI, 1.51–4.60 and HR 18.92, 95% CI, 2.10–170.40, respectively). Conclusions: The presence of abnormal preoperative PFTs is not prohibitory for LVAD implantation although it can be used for risk stratification for respiratory AEs and mortality, particularly in patients with severely reduced metrics. The importance of careful patient selection should be underscored in this higher risk patient subset. [ABSTRACT FROM AUTHOR]

Background: This study evaluated the impact of preoperative angiotensin-converting enzyme inhibitor (ACEi) exposure on outcomes of coronary artery bypass grafting (CABG).Methods: Isolated CABGs from January 2010 to January 2018 at a single institution were included. Primary stratification was based on exposure to an ACEi within 48-hours of CABG. Propensity-matching with a 1:1 ratio was performed to generate cohorts with comparable baseline characteristics. Primary outcomes included operative mortality and morbidity rates as well as prolonged intensive care unit (ICU) stay. Secondary outcomes included hospital readmission.Results: Five-thousand two hundred seventy propensity-matched patients underwent isolated CABG. Baseline characteristics were comparable between those exposed and unexposed to ACEi, with a Society of Thoracic Surgeons predicted risk of mortality of 2.4% in each group (P = .98). Rates of postoperative renal failure (5.0% vs 8.2%; P = .002), new-onset dialysis (1.2% vs 2.2%; P = .004), and prolonged ventilation (7.0% vs 13.4%; P < .0001) were higher in patients without ACEi exposure. The rates of prolonged ICU stay were similar (25.8% vs 27.7%; P = .127). ACEi exposed patients had lower unadjusted (1.7% vs 2.8%; P = .009) and risk-adjusted hazards for mortality at 30-days (hazard ratio, 0.59; 95% confidence interval, 0.40, 0.88; P = .01). Overall readmission rates were similar. Similar findings persisted when limiting the analysis to CABGs performed with the use of cardiopulmonary bypass.Conclusions: This study of 5270 propensity-matched patients suggests that ACEi can safely be continued until the time of CABG without an adverse impact on clinical outcomes, and in fact, may confer an early survival advantage and reduced postoperative renal failure rates. [ABSTRACT FROM AUTHOR]