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DOI: 10.1055/s-0037-1598923
Lower Mortality and Lower Incidence of Device Failure After One Year on Left Ventricular Assist Device Support as a Bridge to Heart Transplantation
Publication History
Publication Date:
03 February 2017 (online)
Objectives: Increasing incidence of end-stage heart failure and at the same time persistence of severe donor organ shortage moved the therapy with left ventricular assist devices (LVAD) to the forefront of surgical heart failure treatment. Moreover, continuous sophistication in the technology of continuous-flow pumps has resulted in increasing proportion of patients on prolonged LVAD support. In this study, we sought to analyze factors associated with prolonged support as a bridge to transplantation and present long-term outcomes of patients supported for at least 1 year after LVAD implantation.
Methods: A total of 163 consecutive patients who underwent an LVAD implantation as a bridge to transplantation were included in the present study. Of them 78 patients were supported for at least one year (prolonged group) whereas 85 patients were supported for less than one year (control group). Factors associated with prolonged support were analyzed using a univariate analysis. Long-term outcomes were presented using Kaplan-Meier estimate analysis.
Results: Male gender (p < 0.001), rapid postoperative extubation (p = 0.018), cessation of smoking at least 6 month prior to surgery (p = 0.040), previous implantation of an ICD (p = 0.001), higher left ventricular mass (p = 0.013) and larger left ventricular end systolic (p = 0.008) and diastolic (p = 0.005) pressures prior to LVAD implantation were associated with prolonged support. Whereas the control group was associated with higher mortality and higher proportion of patients who underwent device exchange due to device failure, explantation due to myocardial recovery were less likely in the prolonged group (p < 0.001). Also, patients from the prolonged group had a significantly higher incidence of higher-grade aortic regurgitation during the follow-up (p = 0.005).
Conclusion: Prolonged LVAD support as a bridge to transplantation is associated with lower mortality and lower incidence of device failure requiring device exchange. However, longer support reduces the chance of device explantation for myocardial recovery and increases the incidence of higher-grade aortic regurgitation in the follow-up.