title: Short and long term outcomes of 200 patients supported by continuous-flow left ventricular assist devices.
abstract: OBJECTIVE
  To study the institutional experience over 8 years with 200 continuous-flow (CF) - left ventricular assist devices (LVAD).
  
  
  METHODS
  We evaluated our institution's LVAD database and analyzed all patients who received a CF LVAD as a bridge to transplant (BTT) or destination therapy from March 2006 until June 2014. We identified 200 patients, of which 179 were implanted with a HeartMate II device (Thoratec Corp., Pleasanton, CA) and 21 received a Heartware HVAD (HeartWare Inc., Framingham, MA).
  
  
  RESULTS
  The mean age of our LVAD recipients was 59.3 years (range 17-81), 76% (152/200) were males, and 49% were implanted for the indication of BTT. The survival rate for our LVAD patients at 30 d, 6 mo, 12 mo, 2 years, 3 years, and 4 years was 94%, 86%, 78%, 71%, 62% and 45% respectively. The mean duration of LVAD support was 581 d (range 2-2595 d). Gastrointestinal bleeding (was the most common adverse event (43/200, 21%), followed by right ventricular failure (38/200, 19%), stroke (31/200, 15%), re exploration for bleeding (31/200, 15%), ventilator dependent respiratory failure (19/200, 9%) and pneumonia (15/200, 7%). Our driveline infection rate was 7%. Pump thrombosis occurred in 6% of patients. Device exchanged was needed in 6% of patients. On multivariate analysis, preoperative liver dysfunction, ventilator dependent respiratory failure, tracheostomy and right ventricular failure requiring right ventricular assist device support were significant predictors of post LVAD survival.
  
  
  CONCLUSIONS
  Short and long term survival for patients on LVAD support are excellent, although outcomes still remain inferior compared to heart transplantation. The incidence of driveline infections, pump thrombosis and pump exchange have declined significantly in recent years.
authors.affiliation: Athanasios Tsiouris, Jeffrey A Morgan, Section of Cardiac Surgery, Yale University School of Medicine, New Haven, CT 06520, United States.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Tsiouris
authors.affiliation: Athanasios Tsiouris, Jeffrey A Morgan, Section of Cardiac Surgery, Yale University School of Medicine, New Haven, CT 06520, United States.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paone
authors.affiliation: Athanasios Tsiouris, Jeffrey A Morgan, Section of Cardiac Surgery, Yale University School of Medicine, New Haven, CT 06520, United States.
authors.forename: Hassan W
authors.initials: HW
authors.lastname: Nemeh
authors.affiliation: Athanasios Tsiouris, Jeffrey A Morgan, Section of Cardiac Surgery, Yale University School of Medicine, New Haven, CT 06520, United States.
authors.forename: Jamil
authors.initials: J
authors.lastname: Borgi
authors.affiliation: Athanasios Tsiouris, Jeffrey A Morgan, Section of Cardiac Surgery, Yale University School of Medicine, New Haven, CT 06520, United States.
authors.forename: Celeste T
authors.initials: CT
authors.lastname: Williams
authors.affiliation: Athanasios Tsiouris, Jeffrey A Morgan, Section of Cardiac Surgery, Yale University School of Medicine, New Haven, CT 06520, United States.
authors.forename: David E
authors.initials: DE
authors.lastname: Lanfear
authors.affiliation: Athanasios Tsiouris, Jeffrey A Morgan, Section of Cardiac Surgery, Yale University School of Medicine, New Haven, CT 06520, United States.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Morgan
keywords: Continuous-flow; Heart failure; Left ventricular assist device; Outcomes