Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Nov 26, 2015; 7(11): 792-800
Published online Nov 26, 2015. doi: 10.4330/wjc.v7.i11.792
Short and long term outcomes of 200 patients supported by continuous-flow left ventricular assist devices
Athanasios Tsiouris, Gaetano Paone, Hassan W Nemeh, Jamil Borgi, Celeste T Williams, David E Lanfear, Jeffrey A Morgan
Athanasios Tsiouris, Jeffrey A Morgan, Section of Cardiac Surgery, Yale University School of Medicine, New Haven, CT 06520, United States
Gaetano Paone, Hassan W Nemeh, Jamil Borgi, Celeste T Williams, David E Lanfear, Division of Cardiac Surgery, Heart and Vascular Institute, Henry Ford Hospital, Detroit, MI 48201, United States
Author contributions: Tsiouris A was responsible for drafting the manuscript, statistical analysis and study design; Paone G, Nemeh HW, Borgi J, Williams CT, Lanfear DE and Morgan JA provided critical analysis of the results and the manuscript and supervised the project.
Institutional review board statement: The study was reviewed and approved by the Henry Ford Hospital Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work, there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Athanasios Tsiouris, MD, Section of Cardiac Surgery, Yale University School of Medicine, 333 Cedar St, Boardman 204, New Haven, CT 06520, United States. athtsiouris@hotmail.com
Telephone: +1-203-7857627
Received: June 6, 2015
Peer-review started: June 6, 2015
First decision: August 10, 2015
Revised: September 9, 2015
Accepted: September 29, 2015
Article in press: September 30, 2015
Published online: November 26, 2015
Processing time: 177 Days and 4.3 Hours
Abstract

AIM: To study the institutional experience over 8 years with 200 continuous-flow (CF) - left ventricular assist devices (LVAD).

METHODS: We evaluated our institution’s LVAD database and analyzed all patients who received a CF LVAD as a bridge to transplant (BTT) or destination therapy from March 2006 until June 2014. We identified 200 patients, of which 179 were implanted with a HeartMate II device (Thoratec Corp., Pleasanton, CA) and 21 received a Heartware HVAD (HeartWare Inc., Framingham, MA).

RESULTS: The mean age of our LVAD recipients was 59.3 years (range 17-81), 76% (152/200) were males, and 49% were implanted for the indication of BTT. The survival rate for our LVAD patients at 30 d, 6 mo, 12 mo, 2 years, 3 years, and 4 years was 94%, 86%, 78%, 71%, 62% and 45% respectively. The mean duration of LVAD support was 581 d (range 2-2595 d). Gastrointestinal bleeding (was the most common adverse event (43/200, 21%), followed by right ventricular failure (38/200, 19%), stroke (31/200, 15%), re exploration for bleeding (31/200, 15%), ventilator dependent respiratory failure (19/200, 9%) and pneumonia (15/200, 7%). Our driveline infection rate was 7%. Pump thrombosis occurred in 6% of patients. Device exchanged was needed in 6% of patients. On multivariate analysis, preoperative liver dysfunction, ventilator dependent respiratory failure, tracheostomy and right ventricular failure requiring right ventricular assist device support were significant predictors of post LVAD survival.

CONCLUSION: Short and long term survival for patients on LVAD support are excellent, although outcomes still remain inferior compared to heart transplantation. The incidence of driveline infections, pump thrombosis and pump exchange have declined significantly in recent years.

Keywords: Left ventricular assist device; Outcomes; Heart failure; Continuous-flow

Core tip: In this paper, we report our experience over the last 8 years with implanting continuous-flow left ventricular assist devices (LVADs). The aim of this analysis is to identify common occurring complications after LVAD implantation and identify areas for potential improvement in both patient management and selection. This is the largest single institutional LVAD experience that has been published, to the best of our knowledge.