Outcomes after implantation of 139 full-support continuous-flow left ventricular assist devices as a bridge to transplantation

• Published in: European journal of cardio-thoracic surgery 2014-11, Vol.46 (5), p.e59-e66
• Main Authors: Sabashnikov, Anton, Mohite, Prashant N., Weymann, Alexander, Patil, Nikhil P., Hedger, Mike, Sáez, Diana García, Zych, Bartlomiej, Wahlers, Thorsten, Wippermann, Jens, De Robertis, Fabio, Bahrami, Toufan, Amrani, Mohamed, Simon, André R., Popov, Aron-Frederik
• Format: Article
• Language: English
• Subjects: Adult; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - methods; Cardiac Surgical Procedures - mortality; Female; Heart Diseases - epidemiology; Heart Diseases - mortality; Heart Diseases - surgery; Heart Transplantation; Heart-Assist Devices - adverse effects; Heart-Assist Devices - statistics & numerical data; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Postoperative Complications - epidemiology; Prosthesis-Related Infections - epidemiology; Retrospective Studies; Treatment Outcome
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezu325

OBJECTIVES Left ventricular assist devices (LVADs) are a routine treatment for patients with advanced heart failure as a bridge to transplantation. The aim of this study was to present our institutional experience and mid-term outcomes after implantation of 139 continuous-flow (cf) LVADs as a bridge to transplantation. METHODS One hundred and thirty-nine consecutive LVAD implantations were performed in our institution between July 2007 and August 2013. The mean age of the population was 44.0 ± 13.7 years and 24 (17%) of the patients were female. A substantial number of the patients were on preoperative mechanical support: 35 (25%) with an intra-aortic balloon pump, 9 (6.5%) with an extracorporeal membrane oxygenator and 25 (18%) with previous LVAD, for LVAD exchange. RESULTS The mean support duration was 514 ± 481 days, whereas the longest support duration was 2493 days (>6 years). The overall cumulative survival rate following cfLVAD implantation was 89% at 30 days, 76% at 1 year and 66% at 2 years (Fig. 1). There was a statistically significant difference in survival in favour of first LVAD implantation compared with VAD exchange: 91 vs 80% at 30 days, 79 vs 57% at 1 year and 70 vs 43% at 2 years (log-rank P = 0.010). Postoperatively, patients had a significant improvement in end-organ function 1 month after LVAD implantation. In addition, comparison of two different devices [HeartMate II (HM II) and HeartWare] using propensity score matching showed no significant differences in survival and most postoperative adverse events. However, patients supported with HM II required significantly more units of fresh frozen plasma (P = 0.020) with a trend towards a higher use of red blood cells (P = 0.094), and were also more likely to develop percutaneous site infections (P = 0.022). CONCLUSIONS HM II and HeartWare cfLVADs have excellent early postoperative outcomes and good mid-term survival, despite a considerable number of patients needing VAD exchange.