title: Continuous-flow ventricular assist device exchange is safe and effective in prolonging support time in patients with end-stage heart failure.
abstract: OBJECTIVE
  Although the development of continuous-flow ventricular assist devices (CF-VAD) has improved the reliability of these devices, VAD exchange is still occasionally necessary. The focus of this study was to analyze our institution's entire experience with primary CF-VAD implants, evaluate the baseline variables, determine which factors predict the need for exchange, and evaluate the impact of exchange on survival and event-free survival.
  
  
  METHODS
  We retrospectively reviewed the data of all patients in a single center who received a primary CF-VAD implant between December 1999 and December 2013. All CF-VAD exchanges were reviewed; demographics, indications, preoperative and operative data, and clinical outcomes were summarized. Univariate and multivariable regression analyses were performed to ascertain predictors for exchange. Time-to-event and survival analyses were also performed.
  
  
  RESULTS
  We identified 469 patients who underwent 546 CF-VAD implantations. Of these patients, 66 (14%) underwent 77 exchanges from one CF-VAD to another. The primary indications included hemolysis or thrombosis (n = 49; 63.6%), infection (n = 9; 11.7%), or other causes (n = 19; 24.7%). Survival was not significantly different between the exchange and nonexchange groups. Multivariable regression analysis identified a history of cerebrovascular events as a significant predictor for exchange. Among exchange patients, 11 underwent heart transplantation, 3 had their CF-VADs explanted, 26 had ongoing support, and 26 died during device support.
  
  
  CONCLUSIONS
  In our series of contemporary CF-VAD exchanges, a history of previous cerebrovascular events was a significant predictor for exchange. Exchange did not affect early or late survival. Our data suggest that aggressive surgical treatment of pump-related complications with exchange is safe and justified.
authors.affiliation: Division of Transplant and Assist Devices, Department of Surgery, Baylor College of Medicine, Houston, Tex.
authors.forename: Jatin
authors.initials: J
authors.lastname: Anand
authors.affiliation: Division of Transplant and Assist Devices, Department of Surgery, Baylor College of Medicine, Houston, Tex.
authors.forename: Steve K
authors.initials: SK
authors.lastname: Singh
authors.affiliation: Center for Cardiac Support, Texas Heart Institute, Houston, Tex.
authors.forename: Rubén
authors.initials: R
authors.lastname: Hernández
authors.affiliation: Center for Cardiac Support, Texas Heart Institute, Houston, Tex.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Parnis
authors.affiliation: Division of Transplant and Assist Devices, Department of Surgery, Baylor College of Medicine, Houston, Tex; Center for Cardiac Support, Texas Heart Institute, Houston, Tex.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Civitello
authors.affiliation: Division of Transplant and Assist Devices, Department of Surgery, Baylor College of Medicine, Houston, Tex; Center for Cardiac Support, Texas Heart Institute, Houston, Tex.
authors.forename: William E
authors.initials: WE
authors.lastname: Cohn
authors.affiliation: Division of Transplant and Assist Devices, Department of Surgery, Baylor College of Medicine, Houston, Tex; Center for Cardiac Support, Texas Heart Institute, Houston, Tex. Electronic address: mallidi@bcm.edu.
authors.forename: Hari R
authors.initials: HR
authors.lastname: Mallidi
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D020878:Device Removal; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas; D013997:Time Factors; D016896:Treatment Outcome; D016276:Ventricular Function