Long-term use of left ventricular assist devices: a report on clinical outcomes

Abstract

Background:The literature examining clinical outcomes and readmissions during extended (> 1 yr) left ventricular assist device (LVAD) support is scarce, particularly in the era of continuous-flow LVADs. Methods:We completed a retrospective cohort study on consecutive LVAD patients from June 2006 to March 2015, focusing on those who received more than 1 year of total LVAD support time. Demographic characteristics, clinical outcomes and readmissions were analyzed using standard statistical methods. All readmissions were categorized as per the Interagency Registry for Mechanically Assisted Circulatory Support 2015 guidelines. Results:Of the 103 patients who received LVADs during the study period, 37 received LVAD support for more than 1 year, with 18 receiving support for more than 2 years. Average support time was 786 ± 381 days, with total support time reaching 80 patient-years. During a median follow-up of 2 years, 27 patients died, with 1-year conditional survival of 74%. Median freedom from first readmission was 106 days (range 1-603 d), with an average length of stay of 6 days. Readmissions resulted in an average of 41 ± 76 days in hospital per patient. Reasons for readmission were major infection (24%), major bleeding (19%) and device malfunction/thrombus (13%). There were a total of 112 procedures completed during the readmissions, with 60% of procedures being done in 13% (n = 5) of patients. Conclusion:Continuous-flow LVADs provide excellent long-term survival. The present study describes marked differences in reasons for readmissions between the general LVAD population and those supported for more than 1 year. Prolonged LVAD support resulted in decreased susceptibility to major bleeds and increased susceptibility to infection. Résultats :Parmi les 103 patients chez qui un DAVG a été implanté durant la période de l'étude, 37 en ont bénéficié pendant plus d'un an et 18 pendant plus de 2 ans. La durée moyenne d'utilisation a été de 786 ± 381 jours, la durée totale de l'assistance ainsi fournie atteignant 80 années-patients. Pendant la période de suivi médiane de 2 ans, 27 patients sont décédés, ce qui correspond à une survie conditionnelle d'un an chez 74 % des participants. L'intervalle médian avant une première réadmission a été de 106 jours (éventail 1-603 jours), et la durée médiane des séjours a été de 6 jours. Les réadmissions ont en moyenne été suivies d'un séjour hospitalier de 41 ± 76 jours par patient. Les raisons des réadmissions ont été infection grave (24 %), hémorragie majeure (19 %) et dysfonction du dispositif/thrombus (13 %). En tout, 112 interventions ont été effectuées lors des réadmissions, 60 % d'entre elles chez 13 % des patients (n = 5). Conclusion :Les DAVG à flux continu donnent lieu à une excellente survie à long terme. La présente étude décrit les différences marquées en ce qui concerne les raisons des réad-missions entre la population générale porteuse d'un DAVG et la population ayant bénéficié du dispositif pendant plus d'un an. Le recours prolongé à un DAVG a été associé à une ...

Comparative Analysis of Established Risk Scores and Novel Hemodynamic Metrics in Predicting Right Ventricular Failure in Left Ventricular Assist Device Patients

“…(1) Despite the widespread adoption and success of LVADs for bridge-to-transplant or destination therapy indications, several attendant complications continue to limit the efficacy of LVADs. (2,3) The prevention and management of certain complications such as bleeding, hemolysis, stroke and driveline infections has fortunately improved, particularly with the newer generation LVADs. (4-7) Conversely, postoperative right ventricular failure (RVF) has persisted as a perennial vexing challenge to LVAD success.…”

Platelet adhesion emulation: A novel method for estimating the device thrombosis potential of a ventricular assist device

“…It is reported that thrombosis and thromboembolic events can occur in up to 20% of patients with an LVAD. 15 Pump thrombosis may cause pump output reduction and even device malfunction, stroke, and thromboembolic events, which expose patients to the risk of sudden death and can necessitate pump-exchange surgery. Although antithrombotic strategies have been adopted to prevent pump thrombosis, the partial efficacy is limited.…”

Left Ventricular Assist Device Infections

“…Clinical outcomes for LVAD implantation have been extensively reviewed (see for example [10,61,74,75]) including for infection. It is estimated that 15% of LVAD recipients die due to infectious complications, with the majority of deaths occurring within the first 30 days of receipt [76].…”