Longterm Survival on LVAD Support: Limitations Driven by Development of Device Complications and End-Organ Dysfunction
Hariri IM, Dardas T, Kanwar M, Cogswell R, Gosev I, Molina E, Myers SL, Kirklin JK, Shah P, Pagani FD, and Cowger JA. Longterm Survival on LVAD Support: Limitations Driven by Development of Device Complications and End-Organ Dysfunction. Journal of Cardiac Failure 2020; 26(10):S143-S144.
Journal of Cardiac Failure
Introduction: Survival is nearly 50% after 5 years of LVAD support. While preop variables can predict short-term (ST) survival, correlates of long term (LT) survival remain poorly characterized. Hypothesis: We hypothesize that preop risk stratification will be limited to predicting ST survival and not LT success.
Method: Patients (n=16474) undergoing LVAD implant (2012-18) in Intermacs-STS were grouped according to time on support: ST (<1 year, n=4468), mid-term (MT, 1-3 years, n=8991) and LT (≥3 years, n=3015). Separate multiphase hazard analyses were performed to identify correlates of LT survival in those alive and on LVAD support at 1 and 3 years (Ys).
Results: Of those alive on LVAD support at 1 Y, the 3, 5, and 6 Y survivals were 75%, 53%, and 45%, respectively. Patients who were alive on LVAD support at 3 Ys had survivals of 60% at 6 Ys. The table shows adjusted associations between clinical variables and mortality for the MT and LT survival groups starting at 1 and 3 Ys, respectively. For the MT group, older, obese and Caucasian patients and those with preop RV dysfunction, active smoking, unmarried status or comorbidities had higher mortality after 1 Y of support. The occurrence of postop malnutrition, renal, and hepatic dysfunction also increased mortality. Finally, each episode of stroke, device infection or device malfunction increased mortality by 13-42%. For the LT group, postop organ dysfunction and malnutrition impacted extended LVAD survival and mortality increased by 10-46% per adverse event. The only preop correlates of survival beyond 3 Ys were older age, Caucasian race, and history of CABG.
Conclusion: The success of LVAD support hinges on achieving LT survival. In operative survivors, LT LVAD survival is heavily constrained by the occurrence of events after LVAD placement. Preop, this also limits our ability to provide individualized, LT survival estimates.