title: Outcomes of patients implanted with a left ventricular assist device at nontransplant mechanical circulatory support centers.
abstract: The goal of this study was to assess outcomes of patients who underwent implantation of left ventricular assist devices (LVADs) at nontransplantation mechanical circulatory support centers. As the availability of LVADs for advanced heart failure has expanded to nontransplantation mechanical circulatory support centers, concerns have been expressed about maintaining good outcomes. Demographics and outcomes were evaluated in 276 patients with advanced heart failure who underwent implantation of LVADs as bridge to transplantation or destination therapy at 27 open-heart centers. Baseline characteristics, operative mortality, length of stay, readmission rate, adverse events, quality of life, and survival were analyzed. The overall 30-day mortality was 3% (8 of 276), and survival rates at 6, 12, and 24 months, respectively, were 92±2%, 88±3%, and 84±4% for the bridge-to-transplantation group and 81±3%, 70±5%, and 63±6% for the destination therapy group, comparable with results published by the national Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). The median length of stay for all patients was 21 days. Bleeding was the most frequent adverse event. Stroke occurred in 4% (bridge to transplantation) and 6% (destination therapy) of patients. Quality-of-life measures and 6-minute walk distances showed sustained improvements throughout support. In conclusion, outcomes with LVAD support at open-heart centers are acceptable and comparable with results from the INTERMACS registry. With appropriate teams, training, center commitment, and certification, LVAD therapy is being disseminated in a responsible way to open-heart centers.
authors.affiliation: Bon Secours Health System, Richmond, Virginia. Electronic address: mkatz@misva.org.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Katz
authors.affiliation: Heart Failure Cardiology, Spectrum Health, Grand Rapids, Michigan.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Dickinson
authors.affiliation: Piedmont Healthcare, Atlanta, Georgia.
authors.forename: Nirav Y
authors.initials: NY
authors.lastname: Raval
authors.affiliation: Atlantic Health System, Morristown, New Jersey.
authors.forename: James P
authors.initials: JP
authors.lastname: Slater
authors.affiliation: Piedmont Healthcare, Atlanta, Georgia.
authors.forename: David A
authors.initials: DA
authors.lastname: Dean
authors.affiliation: Bon Secours Health System, Richmond, Virginia.
authors.forename: Gary R
authors.initials: GR
authors.lastname: Zeevi
authors.affiliation: Weill Cornell Medical Center, New York, New York.
authors.forename: Evelyn M
authors.initials: EM
authors.lastname: Horn
authors.affiliation: Weill Cornell Medical Center, New York, New York.
authors.forename: Arash
authors.initials: A
authors.lastname: Salemi
mesh_terms: D000368:Aged; D002300:Cardiac Care Facilities; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011788:Quality of Life; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome