Left Ventricular Assist Device as a Destination Therapy: Current Situation and the Importance of Patient Selection

Melendo-Viu, María; Dobarro, David; Roubín, Sergio Raposeiras; Pernas, Carmen Llamas; Cordón, Candela Moliz; Lamas, Miriam Vazquez; Esteban, Miguel Piñón; Martínez, Maria Ángela Varela; Assi, Emad Abu; Romero, Rafael Pita; Calderón, Juan José Legarra; Romo, Andrés Íñiguez

doi:10.3390/life13041065

Cited by 4 publications

(5 citation statements)

References 112 publications

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“…The 2022 INTERMACS registry also demonstrated an increased proportion of DT from 50.4% (2012–2016) to 66.4% (2017–2021), while the BTT proportion has declined from 27.5% to 19.5%. Although BTT has better survival rates due to younger age and fewer comorbidities compared to DT, 1-year survival in DT is still acceptable (77%) [ 23 , 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Age Is a Predictor of In-Hospital Outcomes for Left Ventricular Assist Device Implantation: A Nationwide Analysis

Akkawi,

Yamaguchi,

Shimamura

et al. 2024

JPM

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The 2018 heart allocation system has significantly influenced heart transplantation and left ventricular assist device (LVAD) utilization. Our study aims to investigate age-related outcomes following LVAD implantation in the post-allocation era. Using the National Inpatient Sample, we analyzed data from 7375 patients who underwent LVAD implantation between 2019 and 2020. The primary endpoint was in-hospital mortality following LVAD implantation, stratified by age categories. The age groups were 18–49, 50–59, 60–69, and over 70. These represented 26%, 26%, 31%, and 17% of patients, respectively. Patients aged 60–69 and those over 70 exhibited higher in-hospital mortality rates of 12% and 17%, respectively, compared to younger age groups (7% for 18–49 and 6% for 50–59). The age groups 60–69 and over 70 were independent predictors of mortality, with adjusted odds ratios of 1.99 (p = 0.02; 95% confidence interval [CI], 1.12–3.57) and 2.88 (p = 0.002; 95% CI, 1.45–5.71), respectively. Additionally, a higher Charlson Comorbidity Index was associated with increased in-hospital mortality risk (adjusted odds ratio 1.39; p = 0.02; 95% CI, 1.05–1.84). Additionally, patients above 70 experienced a statistically shorter length of stay. Nonhome discharge was found to be significantly high across all age categories. However, the difference in hospitalization cost was not statistically significant across the age groups. Our study highlights that patients aged 60 and above face an increased risk of in-hospital mortality following LVAD implantation in the post-allocation era. This study sheds light on age-related outcomes and emphasizes the importance of considering age in LVAD patient selection and management strategies.

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Section: Discussionmentioning

confidence: 99%

Age Is a Predictor of In-Hospital Outcomes for Left Ventricular Assist Device Implantation: A Nationwide Analysis

Akkawi,

Yamaguchi,

Shimamura

et al. 2024

JPM

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“…One of the standard exclusion criteria for LVADs and HTs in patients with advanced heart failure is multi-system organ dysfunction 17 . However, recent studies have shown that LVADs may be performed in patients with severe renal insufficiency without an increase in mortality and morbidity 18 .…”

Section: Discussionmentioning

confidence: 99%

“…However, recent studies have shown that LVADs may be performed in patients with severe renal insufficiency without an increase in mortality and morbidity 18 . Similarly, liver cirrhosis is no longer a formal contraindication, and select patients can qualify for LVAD, but 'irreversible liver damage' is still considered a contraindication 17 . Interestingly, our study noted that the highest use of LVADs was with multiorgan failure and single organ failure as compared to no organ failure in both the non-AMI CS group and the all-CS group.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Clinical Outcomes of Acute Noncardiac Organ Failure among Non-Acute Myocardial Infarction Cardiogenic Shock: A Nationwide Cohort Analysis

Majmundar,

Faisaluddin,

Alarfaj

et al. 2024

Preprint

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Background: Noncardiac organ failure often complicates cardiogenic shock (CS). The results of cardiogenic shock caused by noncardiac organ failures in patients without acute myocardial infarction (AMI) are not well documented. Methods: We examined the National Inpatient Sample (NIS) data from 2016 to 2020 to identify cases of CS and non-AMI CS-related hospitalizations. We divided both cohorts based on the number of acute noncardiac organ failures and evaluated the influence of organ failure on the primary outcome, which was in-hospital mortality. Results: A total of 599,210 (100%) cardiogenic shock and 366,905 (61.2%) non-AMI CS hospitalizations were identified. Among those with non-AMI CS, 58,965 (16.07%) had no organ failure, 121,845 (33.21%) had a single organ failure, and 186,095 (50.72%) had a multiorgan failure. Acute Kidney Injury (AKI) was the most common non-cardiac organ failure (38.1%). Multiorgan failure was associated with an increased risk of in-hospital mortality (aOR: 4.91, 95% CI: 4.72-5.06, p <0.001) compared to no organ failure. A notable increase in mortality rates was observed in correlation with the number of organ involvement. The highest mortality rates were seen in cases where five or more organs were affected. Neurological failure exhibited a significant association with mortality when compared to other organ failures. Similar trends were seen among the CS cohort. Conclusions: In non-acute myocardial infarction and all cardiogenic shock patients, AKI is the most common type of organ failure, and neurological failure was associated with the highest mortality rate. The presence of noncardiac multiorgan failure was found to be strongly associated with a higher mortality rate. This risk increased as more organs were affected. ?

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“…The presence of valve disease is also considered, with severe mitral stenosis and mild aortic regurgitation classified as contraindications. A neurological and cognitive assessment will also be conducted, since moderate-severe cognitive impairment and dementia are contraindications for MCS [25]. Together, these considerations enable healthcare providers to make informed decisions regarding patient suitability for device implantation, aiming to improve patient care.…”

Section: Complications In Mcs 21 Patient Selection and Challenges In ...mentioning

confidence: 99%

The Evolution and Complications of Long-Term Mechanical Circulatory Support Devices

Sargent,

Ali,

Kanamarlapudi

2024

Hearts

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Heart failure, a common clinical syndrome caused by functional and structural abnormalities of the heart, affects 64 million people worldwide. Long-term mechanical circulatory support can offer lifesaving treatment for end-stage systolic heart failure patients. However, this treatment is not without complications. This review covers the major complications associated with implantable mechanical circulatory support devices, including strokes, pump thrombosis and gastrointestinal bleeding. These complications were assessed in patients implanted with the following devices: Novacor, HeartMate XVE, CardioWest, Jarvik 2000, HeartMate II, EVAHEART, Incor, VentrAssist, HVAD and HeartMate 3. Complication rates vary among devices and remain despite the introduction of more advanced technology, highlighting the importance of device design and flow patterns. Beyond clinical implications, the cost of complications was explored, highlighting the difference in costs and the need for equitable healthcare, especially with the expected rise in the use of mechanical circulatory support. Future directions include continued improvement through advancements in design and technology to reduce blood stagnation and mitigate high levels of shear stress. Ultimately, these alterations can reduce complications and enhance cost-effectiveness, enhancing both the survival and quality of life for patients receiving mechanical circulatory support.

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Left Ventricular Assist Device as a Destination Therapy: Current Situation and the Importance of Patient Selection

Cited by 4 publications

References 112 publications

Age Is a Predictor of In-Hospital Outcomes for Left Ventricular Assist Device Implantation: A Nationwide Analysis

Age Is a Predictor of In-Hospital Outcomes for Left Ventricular Assist Device Implantation: A Nationwide Analysis

Prevalence and Clinical Outcomes of Acute Noncardiac Organ Failure among Non-Acute Myocardial Infarction Cardiogenic Shock: A Nationwide Cohort Analysis

The Evolution and Complications of Long-Term Mechanical Circulatory Support Devices

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