Continuous Flow Left Ventricular Assist Device Improves Functional Capacity and Quality of Life of Advanced Heart Failure Patients

Rogers, Joseph G.; Aaronson, Keith D.; Boyle, Andrew; Russell, Stuart D.; Milano, Carmelo A.; Pagani, Francis D.; Edwards, Brooks S.; Park, Soon; John, Ranjit; Conte, John V.; Farrar, David J.; Slaughter, Mark S.

doi:10.1016/j.jacc.2009.12.052

Cited by 528 publications

(349 citation statements)

References 35 publications

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“…Continuous flow LVADs (CF‐LVADs) have been shown to improve mortality, morbidity, functional status, and quality of life in patients with advanced HF 2, 3, 4. Ventricular arrhythmias, however, are commonly seen in patients with LVAD,5, 6, 7 and the vast majority of LVAD recipients who had implantable cardioverter defibrillators (ICDs) continue to receive ICD therapies post‐LVAD implant 8.…”

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confidence: 99%

Cardiac Resynchronization Therapy and Clinical Outcomes in Continuous Flow Left Ventricular Assist Device Recipients

Gopinathannair

Roukoz

Bhan

et al. 2018

JAHA

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BackgroundMany patients with heart failure continue cardiac resynchronization therapy (CRT) after continuous flow left ventricular assist device (CF‐LVAD) implant. We report the first multicenter study to assess the impact of CRT on clinical outcomes in CF‐LVAD patients.Methods and ResultsAnalysis was performed on 488 patients (58±13 years, 81% male) with an implantable cardioverter defibrillator (ICD) (n=223) or CRT‐D (n=265) who underwent CF‐LVAD implantation at 5 centers from 2007 to 2015. Effects of CRT on mortality, hospitalizations, and ventricular arrhythmia incidence were compared against CF‐LVAD patients with an ICD alone. Baseline differences were noted between the 2 groups in age (60±12 versus 55±14, P<0.001) and QRS duration (159±29 versus 126±34, P=0.001). Median biventricular pacing in the CRT group was 96%. During a median follow‐up of 478 days, Kaplan–Meier analysis showed no difference in survival between groups (log rank P=0.28). Multivariate Cox regression demonstrated no survival benefit with type of device (ICD versus CRT‐D; P=0.16), whereas use of amiodarone was associated with increased mortality (hazard ratio 1.77, 95% confidence interval 1.1–2.8, P=0.01). No differences were noted between CRT and ICD groups in all‐cause (P=0.06) and heart failure (P=0.9) hospitalizations, ventricular arrhythmia incidence (43% versus 39%, P=0.3), or ICD shocks (35% versus 29%, P=0.2). During follow‐up, 69 (26%) patients underwent pulse generator replacement in the CRT‐D group compared with 36 (15.5%) in the ICD group (P=0.003).ConclusionsIn this large, multicenter CF‐LVAD cohort, continued CRT was not associated with improved survival, hospitalizations, incidence of ventricular arrhythmia and ICD therapies, and was related to a significantly higher number of pulse generator changes.

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confidence: 99%

Cardiac Resynchronization Therapy and Clinical Outcomes in Continuous Flow Left Ventricular Assist Device Recipients

Gopinathannair

Roukoz

Bhan

et al. 2018

JAHA

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“…9 The functional capacity and quality of life reported in this trial are encouraging, as has been reported also for the continuous axial flow devices. 10 The 6-minute walk distance in this trial improved markedly from a baseline at which Ͼhalf of patients had an imputed value of 0 as unable to walk. The quality of life achieved was comparable with that achieved after cardiac resynchronization therapy in a healthier population at baseline.…”

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confidence: 74%

A Bridge Far Enough?

Stevenson

Hunt

2012

Circulation

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“…An often overlooked point in the CF-LVAD patients is that they desire and attempt to regain normalcy through social interactions and activities away from home as their heart failure symptoms improve [9]. This can often be restricted by daily/BID dressing changes.…”

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confidence: 99%

The Efficacy of Acticoat-Silver Dressing in Preventing Left-entricular-Assisted Device Infections

Zainah¹,

Karthikeyan²,

Buitron³

et al. 2016

Immunochem Immunopathol

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Background: The optimal local care of continuous-flow left ventricular-assisted device (CF-LVAD) exit site in unclear. We compared silver-coated wound dressing (Acticoat) with the conventional wound care method. Methods:A retrospective case-control study was conducted at Henry Ford Hospital, a tertiary teaching hospital in urban Detroit, between 11/1/2010 and 12/31/2011. Patients were divided into 2 groups based on Acticoatdressing use. Primary outcome was first CF-LVAD infection rate.Results: Forty-two patients were included in the study. Twenty patients used Acticoat-dressing, while 22 used the control dressing. Mean age was 60.3 ± 8.9 in the intervention group and 48.6 ± 4.8 in the control group (P: 0.004). Male patients were 15 (75%) in the intervention group and 15 (68.2%) in the control group (P: 0.74). Acticoat-dressing was used for a mean duration of 64.1 ± 122.9 days. The rate of first CF-LVAD infection was 15% (3) in the Acticoat group and 31.8% (7) in the control group (P: 0.25). Mortality at 200 days was 15% (3) in the intervention group; and 4.5% (1) in the control group (P: 0.25). Ten patients were infected in the whole study (23.8%); 9 of the infected patients (90%) required hospitalization after the first infection; while 3 patients (30%) required intensive-care unit admission. Mean time to the first infection was 276.3 ± 235.8 days in the intervention group and 276.3 ± 131.5 days in the control group (P: 0.99).

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Continuous Flow Left Ventricular Assist Device Improves Functional Capacity and Quality of Life of Advanced Heart Failure Patients

Abstract: Use of a continuous flow LVAD in advanced heart failure patients results in clinically relevant improvements in functional capacity and heart failure-related quality of life.

Cited by 528 publications

References 35 publications

Cardiac Resynchronization Therapy and Clinical Outcomes in Continuous Flow Left Ventricular Assist Device Recipients

Cardiac Resynchronization Therapy and Clinical Outcomes in Continuous Flow Left Ventricular Assist Device Recipients

A Bridge Far Enough?

The Efficacy of Acticoat-Silver Dressing in Preventing Left-entricular-Assisted Device Infections

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