Ventricular Assist Device Patient Phenotypes: What Attributes Describe Long Term Survival?
Hariri IM, Hannawi B, Grafton G, Nemeh HW, Chamogeorgakis T, Lanfear DE, Apostolou D, Selektor Y, Williams CT, Tita C, Tanaka D, Myers SL, Kirklin JK, Pagani FD, and Cowger JA. Ventricular Assist Device Patient Phenotypes: What Attributes Describe Long Term Survival? Journal of Heart and Lung Transplantation 2020; 39(4):S181-S182.
J Heart Lung Transplant
Purpose: Presently, 50% of patients on LVAD support are alive on therapy at 5 years. While preoperative (preop) variables can predict short term (ST) survival, correlates of long term (LT) survival remain poorly characterized. Using Intermacs-STS, we aim to identify preop and postoperative correlates of LT survival. Methods: Patients (n=16474) undergoing LVAD implant (2012-18) in Intermacs-STS were categorized as ST (survival ≤1 year postoperative, n=7483), mid-term (MT, 1-3 years, n=5976) and LT (>3 years, n=3015) survivors. Pre-implant characteristics and events during support were compared between the three groups to identify mortality correlates. Results: Compared with patients dying in the ST, LT survivors were more likely to be younger, not listed for transplant, with higher BSA and VAS scores and several lower risk preop characteristics but differences between MT and LT survivors were not clinically significant (table). On multi-variable analysis, patients suffering post-LVAD stroke (HR 1.42, image), any major infection (HR 1.13), pump related infection (HR 1.19), and/or device malfunction (HR=1.22) (all p<0.001) were less likely to live >1 year, as were patients with a history of pulmonary disease (HR 1.19, 0.01), cancer (HR 1.26, p=0.01), CABG (HR 1.24, p<0.001), hepatitis (HR 1.54, p=0.002) and active smoking (1.44, p <0.001). Conclusion: The preop clinical features of ST and LT survivors vary significantly. Preop characteristics mainly select out early deaths, failing to accurately characterize survival after 1 year. LT survival is heavily influenced by device complications and pre-existing medical co-morbidities.