Short and longterm outcomes of continuousflow left ventricular assist device therapy in 79 patients with endstage heart failure

Abstract

INTRODUCTION: An increasing number of patients with end-stage heart failure, along with a shortage of heart donors, necessitates the use of mechanical circulatory support. OBJECTIVES: This single-center retrospective study evaluated short- and long-term outcomes of continuous-flow left ventricular assist device (CF-LVAD) therapy in patients with end-stage heart failure. PATIENTS AND METHODS: We collected and assessed data of 79 patients (77 men, 2 women; mean age, 50.3 years; mean INTERMACS profile, 3.1) implanted with a CF-LVAD between 2009 and 2017 (HeartMate 3 in 19 patients [24%]; HeartMate 2 in 9 [11.4%]; and HeartWare in 51 [64.6%]). RESULTS: The mean time on CF-LVAD support was 605 days (range, 1-1834 days). There were 2 device exchanges due to pump thrombosis and 1 explantation due to heart regeneration; 9 patients (11.4%) underwent heart transplant. Stroke (nondisabling, 48%) occurred in 27.8% of patients (ischemic in 9 patients; hemorrhagic, in 14; both types, in 1) despite the standardized anticoagulation regimen. Major gastrointestinal bleeding and pump thrombosis were reported in 13 patients (16.4%), while 18 patients (22.8%) developed driveline infections (recurrent in 15 patients [19%]). Hemorrhagic stroke and bacteremia had a negative impact on survival. Hemorrhagic stroke was the main cause of death. Survival probability was 0.9 at 1 month and 0.8, 0.69, 0.58, and 0.46 at 1, 2, 3, and 4 years, respectively. CONCLUSIONS: Although CF-LVAD support is associated with substantial adverse events, they do not significantly affect mortality (except hemorrhagic stroke and bacteremia). Novel devices seem to overcome these limitations, but larger studies are needed to support these findings.