title: Single-centre experience of 85 patients with a continuous-flow left ventricular assist device: clinical practice and outcome after extended support.
abstract: OBJECTIVE
  We evaluated our single-centre clinical experience with the HeartMate II (HM II) left ventricular assist device (LVAD) as a bridge to transplantation (BTT) in end-stage heart failure (HF) patients.
  
  
  METHODS
  Survival rates, echocardiographic parameters, laboratory values and adverse events of 85 consecutive patients supported with a HM II were evaluated.
  
  
  RESULTS
  Overall, mean age was 45 ± 13 years, 62 (73%) were male and non-ischaemic dilatated cardiomyopathy was present in 60 (71%) patients. The median duration of mechanical support was 387 days (IQR 150-600), with a range of 1-1835 days. The 6-month, 1-, 2-, 3- and 4-year survival rates during HM II LVAD support were 85, 81, 76, 76 and 68%, respectively. Echocardiographic parameters demonstrated effective left ventricular unloading, while laboratory results reflected adequate organ perfusion. However, HM II support was associated with adverse events, such as infections in 42 patients (49%; 0.67 events/patient-year), cardiac arrhythmia in 44 (52%; 0.86 events/patient-year), bleeding complications in 32 (38%; 0.43 events/patient-year) and neurological dysfunction in 17 (20%; 0.19 events/patient-year).
  
  
  CONCLUSIONS
  In view of the increasing shortage of donor hearts, HM II LVAD support may be considered a life-saving treatment in end-stage HF patients, with good survival. However, it is still associated with some serious adverse events, of which neurological complications are the most critical.
authors.affiliation: Department of Cardiology, University Medical Center, Utrecht, The Netherlands. s.lok@umcutrecht.nl
authors.forename: Sjoukje I
authors.initials: SI
authors.lastname: Lok
authors.forename: Jerson R
authors.initials: JR
authors.lastname: Martina
authors.forename: Tim
authors.initials: T
authors.lastname: Hesselink
authors.forename: Ben F M
authors.initials: BF
authors.lastname: Rodermans
authors.forename: Nelienke
authors.initials: N
authors.lastname: Hulstein
authors.forename: Bjorn
authors.initials: B
authors.lastname: Winkens
authors.forename: Corinne
authors.initials: C
authors.lastname: Klöpping
authors.forename: J Hans
authors.initials: JH
authors.lastname: Kirkels
authors.forename: Pieter A
authors.initials: PA
authors.lastname: Doevendans
authors.forename: Faiz
authors.initials: F
authors.lastname: Ramjankhan
authors.forename: Roel A
authors.initials: RA
authors.lastname: de Weger
authors.forename: Nicolaas
authors.initials: N
authors.lastname: de Jonge
authors.forename: Jaap R
authors.initials: JR
authors.lastname: Lahpor
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D016896:Treatment Outcome
keywords: Adverse events; Continuous-flow LVAD; HeartMate II; Survival