Outcomes After Continuous-Flow Left Ventricular Assist Device Implantation as Destination Therapy at Transplant Versus Nontransplant Centers

Abstract

BACKGROUND: Since Food and Drug Administration's approval of the HeartMate II left ventricular assist device (LVAD) as destination therapy, the number of hospitals offering LVAD therapy has grown rapidly. A rising number are performed at centers without internal transplant programs. We sought to determine whether outcomes after destination therapy LVAD implantation are similar at transplant and nontransplant centers. METHODS AND RESULTS: Adult recipients of a primary, continuous-flow LVAD as destination therapy between January 2012 and March 2014 from the Interagency Registry for Mechanically Assisted Circulatory Support were included. Subjects were classified by implanting center as transplant (n=3323) or nontransplant (n=260). Center volume before 2012 was categorized as <15 or ≥15 implants. Outcomes included overall survival, freedom from death or major adverse event, rates of individual adverse events, rehospitalization, and health-related quality of life. Patients treated at nontransplant centers were generally less sick, with higher Interagency Registry for Mechanically Assisted Circulatory Support patient profiles and more normal laboratory and hemodynamic values. One-month (94.2% [95% confidence interval {CI}, 95.0-93.4] versus 94.2% [95% CI, 97.1-91.4]) and 12-month (76.4% [95% CI, 77.9-74.8] versus 71.3% [95% CI, 77.4-65.2]) survival were similar at transplant and nontransplant centers, respectively (hazard ratio, 0.88 [95% CI, 0.70-1.12]). Risk remained similar after adjustment for baseline characteristics (hazard ratio, 0.88 [95% CI, 0.69-1.12]). Freedom from death or major adverse event at 12 months (29.0% [95% CI, 30.6-27.3] versus 29.8% [95% CI, 36.0-23.6]) was similar at transplant and nontransplant centers (adjusted hazard ratio, 1.01 [95% CI, 0.87-1.18]). Individual adverse event rates, rehospitalization, and postimplant health-related quality of life were also similar. CONCLUSIONS: In a large, modern cohort of destination therapy LVAD recipients, outcomes after implantation were similar at transplant and nontransplant centers.