Worldwide experience of adult patients with small body size supported by a continuous-flow left ventricular assist device-an IMACS analysis
Lee S, Xie R, Lemstrom K, Dickinson MG, Boeve T, Leacche M, Cowger J, De By T, Kirklin JK. Worldwide experience of adult patients with small body size supported by a continuous-flow left ventricular assist device-an IMACS analysis. J Heart Lung Transplant. 2018;37(4):S145.
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).