Original article
Adult cardiac
Outcomes on Continuous Flow Left Ventricular Assist Devices: A Single Institutional 9-Year Experience

https://doi.org/10.1016/j.athoracsur.2016.03.026Get rights and content

Background

Continuous-flow left ventricular assist devices (LVADs) have become the standard of care for patients with advanced heart failure. The goal of this study was to review our 9-year institutional experience.

Methods

From March 2006 through May 2015, 231 patients underwent implantation of 240 CF LVADs, HeartMate II LVAD (Thoratec Corp., Pleasanton, CA; n = 205) or HVAD (HeartWare Inc., Framingham, MA; n = 35). Of these, 127 devices (52.9%) were implanted as bridge to transplantation (BTT) and 113 (47.1%) as destination therapy (DT).

Results

Mean age was 51.2 ± 11.9 years for BTT patients and 58.2 ± 11.4 years for DT patients (p < 0.001). There was a higher incidence of preoperative diabetes, renal insufficiency, peripheral vascular disease, and previous cardiac operation in DT patients (p < 0.05). Survival was higher for BTT patients, with 1-, 6-, 12-, and 24-month survivals of 91.0%, 90.0%, 88.5%, and 72.1%, respectively, versus 85.3%, 81.1%, 75.6%, and 59.0%, respectively, for DT patients (p = 0.038). Gastrointestinal bleeding was the most common complication (29.6%), followed by right ventricular failure (22.5%) and stroke (15.0%), with a similar incidence for BTT and DT patients. Preoperative liver biopsy (hazard ratio [HR] 2.27, p = 0.036), mechanical support (HR 1.82, p = 0.025), aspartate transaminase (HR 1.07, p = 0.001), and alanine aminotransferase (HR 0.95, p = 0.024) were severe independent predictors of survival in multivariate analysis.

Conclusions

These data indicate excellent survival for BTT and DT patients on long-term LVAD support. However, for LVAD therapy to become a plausible alternative to heart transplantation, we need to further decrease the incidence of postoperative complications.

Section snippets

Material and Methods

Our health system’s institutional review board approved this retrospective study. We reviewed our institution’s LVAD data set and analyzed patients who underwent CF LVAD implantation as a BTT or DT from March 2006 through May 2015. Two hundred thirty-one patients who underwent 240 device implants (9 were device exchanges) were identified and formed the cohort of this study. Patients received either HeartMate II LVADs (n = 205) or HeartWare HVADs (n = 35).

Demographic and Operative Characteristics of LVAD Recipients

Mean age of our overall patient cohort was 54.5 ± 12.1 years (range, 17 to 81 years), 25.4% were women, and the indication for LVAD implantation was 52.9% in the BTT cohort and 47.1% in the DT cohort. Patients who received LVAD therapy as a BTT were significantly younger (51.2 ± 11.9 versus 58.2 ± 11.4 years, p < 0.001). Additional demographic characteristics and comorbidities are summarized in Table 1. Patients in the BTT cohort were more likely to have nonischemic dilated cardiomyopathy as

Comment

Continuous flow LVADs have substantially altered the expected survival for patients with end-stage heart failure refractory to optimal medical therapy 11, 12, 13. Patients implanted as a BTT or DT have substantially increased survival compared with patients implanted with the older generation HeartMate XVE device [11]. However, both the HM II and HVAD devices are associated with a relatively high incidence of device-related complications, such as GIB, RV failure, stroke, and DL infections 14, 15

References (26)

  • E.A. Rose et al.

    Long-term use of a left ventricular assist device for end-stage heart failure

    N Engl J Med

    (2001)
  • M.S. Slaughter et al.

    Advanced heart failure treated with continuous-flow left ventricular assist device

    N Engl J Med

    (2009)
  • L.W. Miller et al.

    Use of a continuous-flow device in patients awaiting heart transplantation

    N Engl J Med

    (2007)
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