Outcomes on Continuous Flow Left Ventricular Assist Devices: A Single Institutional 9-Year Experience
Morgan JA, Go PH, Xuereb L, Kaur B, Akrawe S, Nemeh HW, Borgi J, Lanfear DE, Williams CT, Paone G. Outcomes on Continuous Flow Left Ventricular Assist Devices: A Single Institutional 9-Year Experience. Ann Thorac Surg. 2016 Oct;102(4):1266-73.
The Annals of thoracic surgery
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.
Medical Subject Headings
Adult; Databases, Factual; Echocardiography, Doppler; Female; Follow-Up Studies; Heart Failure; Heart-Assist Devices; Hemodynamics; Humans; Kaplan-Meier Estimate; Length of Stay; Male; Middle Aged; Monitoring, Physiologic; Multivariate Analysis; Operative Time; Predictive Value of Tests; Proportional Hazards Models; Prosthesis Design; Prosthesis Failure; Retrospective Studies; Risk Assessment; Severity of Illness Index; Statistics, Nonparametric; Survival Rate; Treatment Outcome