Comparison of outcomes in women versus men using a continuous-flow left ventricular assist device as a bridge to transplantation.
BACKGROUND
The use of large, pulsatile left ventricular assist devices (LVADs) has been limited in women because of their small body size.


METHODS
We compared the survival outcomes, quality of life, and adverse events in 465 patients (104 women, 361 men) with advanced systolic heart failure in their first 18 months of support with the HeartMate II (Thoratec Corp, Pleasanton, CA) continuous-flow LVAD for bridge to transplantation.


RESULTS
During the first 18 months, there were no differences in survival between women and men while on LVAD support (73% ± 3% vs 73% ± 5%, p = 0.855) but fewer women (40%) underwent heart transplantation than did men (55%; p = 0.001). More women continued on support after 18 months (p = 0.007). Median duration of support was 238 days for women and 184 days for men (p = 0.003). Mortality was 20% for women and 19% for men (p = 0.89). Adverse events were similar, with the exception of hemorrhagic stroke, which occurred more frequently in women (0.10 vs 0.04 events/patient-year, p = 0.02), and device-related infections, which occurred less frequently in women (0.23 vs 0.44, p = 0.006). Functional capacity and quality of life at 6 months improved significantly in women and men.


CONCLUSIONS
Continuous-flow left ventricular assistance as a bridge to transplantation is associated with similar survival rates in women and men. Differences observed in higher stroke rates and fewer infections among women require further study.
Baylor College of Medicine, St. Luke's Episcopal Hospital, Houston, Texas, USA. rbogaev@heart.thi.tmc.edu
Roberta C
RC
Bogaev
Salpy V
SV
Pamboukian
Stephanie A
SA
Moore
Leway
L
Chen
Ranjit
R
John
Andrew J
AJ
Boyle
Kartik S
KS
Sundareswaran
David J
DJ
Farrar
O H
OH
Frazier
D000328:Adult; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D012727:Sex Characteristics; D020521:Stroke / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome