title: Lessons learned from 150 continuous-flow left ventricular assist devices: a single institutional 7 year experience.
abstract: Continuous-flow (CF) left ventricular assist devices (LVADs) have become the standard of care for patients with advanced heart failure refractory to optimal medical therapy. The goal of this study was to review our 7 year single institutional experience with CF LVADs. Mean age was 50.4 + 12.5 (17-69) years for bridge-to-transplantation (BTT) patients and 57.6 + 10.4 (31-81) years for destination therapy (DT) patients (p < 0.001). Overall, 38 patients (26%) were female and 58 (41%) were African American. Etiology of heart failure was ischemic in 54 patients (37%) and nonischemic in 93 patients (63%). Overall survival at 30 days, 6 months, 12 months, and 2 years was 93%, 89%, 84%, and 81%, respectively. Gastrointestinal bleeding (GIB) was the most common complication (24%), followed by stroke (18%), right ventricular (RV) failure (18%), ventilator-dependent respiratory failure (10%), reoperation for bleeding (10%), and driveline infection (9%). These data demonstrate excellent survival with low mortality for both BTT and DT patients on long-term LVAD support. However, for LVAD therapy to become the gold standard for long-term treatment of end-stage heart failure and a plausible alternative to heart transplantation, we need to continue to improve the incidence of frequent postoperative complications, such as RV failure, driveline infections, strokes, and GIB.
authors.affiliation: From the *Section of Cardiac Surgery, Yale University, School of Medicine, New Haven, Connecticut; and †Division of Cardiothoracic Surgery, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Tsiouris
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paone
authors.forename: Hassan W
authors.initials: HW
authors.lastname: Nemeh
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Brewer
authors.forename: Jamil
authors.initials: J
authors.lastname: Borgi
authors.forename: Arielle
authors.initials: A
authors.lastname: Hodari
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Morgan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult