Worldwide experience of adult patients with small body size supported by a continuous-flow left ventricular assist device-an IMACS analysis

Document Type

Conference Proceeding

Publication Date


Publication Title

J Heart Lung Transplant


Purpose: The use of continuous-flow left ventricular assist devices (CF-LVADs) in adult patients with small body size is increasing worldwide. Our purpose is to compare the characteristics, adverse events (AE) and survival outcomes of patients with body surface area (BSA) < 1.5 m2 (small) to ≥ 1.5 m2 (big) implanted with a CF-LVAD in a large international registry. Methods: The ISHLT Mechanically Assisted Circulatory Support (IMACS) Registry of all adult patients (≥ 18 years of age) who had a CF-LVAD from 1/2013-12/2016 (n= 13038) was examined: 396/13038 (3.1%) had BSA < 1.5 m2 (median 1.36±0.12 m2) vs. n= 12499/13038 (96.9%) had BSA ≥ 1.5 m2 (median 2.05±0.29 m2). Results: Compared to larger patients, small BSA patients were more commonly younger (19-29 yrs. of age) [37/396 (9.3%)] vs. [559/12499 (4.5%); p< 0.0001] and female [217/396 (54.8%) vs. 2429/12499 (19.5%); p< 0.0001]. There was no difference in centrifugal vs. axial flow pumps implanted (p= 0.13) or Intermacs profile at implant (p= ns) in small vs. big patients. Small patients had more bleeding early (< 3 mo. post implant; p= 0.02) and late (p= 0.03) along with a higher rate of late infection and late neurological dysfunction (Table) than big patients. There were no differences in early (p= 0.27) or late (p= 0.18) device malfunction and no differences in post implant survival (p= 0.65). Conclusion: There are important demographic differences and AE profiles in small vs. big patients implanted with CF-LVADs with comparable post implant survival. This data support the use of CF-LVAD in properly selected small adult patients at experienced centers worldwide (Table presented).