Impact of gender in patients with continuous-flow left ventricular assist device therapy in end-stage heart failure

Abstract

Background: There is an ongoing debate about the influence of the female gender on postoperative outcomes after durable left ventricular assist device (LVAD) implantation. Despite the differences in pathophysiology of heart failure in females, therapy concepts are the same as in the male population. The aim of this study was to investigate the role of the female gender in surgical heart failure therapy. Materials and methods: Between August 2010 and January 2020, 207 patients were treated with durable LVAD at out institution. We matched 111 patients in two groups to compare the outcomes in male and female patients and to stratify the risk factors of mortality. Results: The groups were matched 2:1 and were comparable after matching. We found no difference in in-hospital and follow-up mortality between male and female patients. Postoperative adverse events and complications were found to be unvaried across male and female patients. Female patients had higher rates of postoperative LVAD-thrombosis compared to their male counterparts (13.5% vs 0, p = 0.001) and the rates of renal replacement therapy lasting over 90 days were also higher in the female group (33.8% vs 56.8%, p = 0.021). Furthermore, the female gender was not an independent predictor neither of in-hospital nor follow-up mortality. Conclusions: Durable continuous flow left ventricular assist devices as a bridge to transplantation or recovery in female patients are associated with a higher risk of acute kidney injury requiring RRT and are at a higher risk of LVAD-thrombosis. Nevertheless, survival rates between genders are similar.

Durable mechanical circulatory support as bridge to heart transplantation

“…Sadly, recent reports examining sex-related differences following LVAD implantation suggest a disparity in outcomes continues to exist. Zubarevich et al reported on a 2:1 propensity matched study of 111 patients (74 male, 37 female) who had undergone durable LVAD implant between 2010 and 2020 [16 ▪ ]. While there were no differences in survival found, females had a greater incidence of LVAD thrombosis (13.5 vs. 0%, P = 0.001) and prolonged need of renal replacement therapy >90 days (56.8 vs. 33.8%, P = 0.021) compared to males in the follow-up period.…”

Artificial Muscles and Soft Robotic Devices for Treatment of End‐Stage Heart Failure

“…[20][21][22][23][24][25][26] Due to the contact formed between blood and the artificial surfaces, patients need lifelong anticoagulation treatment. [27][28][29] Most importantly, with an incidence of up to 20% of patients, [30,31] the risk of thrombosis (Figure 1a) eventually resulting in a stroke remains a serious complication for VAD recipients. Moreover, due to the still necessary external power supply, patients may suffer further complications such as driveline infections.…”