Patients Awaiting Heart Transplantation on HVAD Support for Greater Than 2 Years.
Advanced heart failure patients who are classified as bridge to transplant (BTT) often remain on mechanical circulatory support (MCS) for long durations because of the limited supply of donor organs. Here, we present the outcomes of patients who have been supported by the HeartWare ventricular assist device system for more than 2 years. In the HeartWare BTT and continued access protocol trial, 74 of the 382 total patients (19.4%) had more than 2 years of MCS with a mean time of 1,045 days on device. The long-term group was more frequently female, was nonwhite, and had Interagency Registry for Mechanically Assisted Circulatory Support profiles 4-7. Postimplant adverse event rates including bleeding, cardiac arrhythmia, infection, stroke, renal dysfunction, and right heart failure were less frequent in the long-term cohort. In addition, the long-term cohort displayed significant improvements in Kansas City Cardiomyopathy Questionnaire Overall Summary Score, EuroQOL-5D Overall Health State Score, and 6 minute walk scores from baseline values. The rate of heart transplantation was lower for the long-term cohort, which may have been a result of their sex and blood type. However, most of these patients are still listed for cardiac transplantation and maintained their quality of life profiles through 3 years of support.
From the *Division of Cardiovascular Medicine, Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan; †Department of Thoracic and Cardiovascular Surgery, Florida Hospital, Orlando, Florida; ‡Department of Cardiac Surgery, Mayo Clinic Rochester, Rochester, Minnesota; §Heart and Lung Transplant Center, Texas Heart Institute, St. Luke's Episcopal Hospital, Houston, Texas; ¶Departments of Internal Medicine and Cardiac Surgery, MedStar Heart Institute, Washington, DC; ‖HeartWare Inc., Framingham, Massachusetts; and #Division of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky.
Keith D
KD
Aaronson
Scott C
SC
Silvestry
Simon
S
Maltais
Hari R
HR
Mallidi
O H
OH
Frazier
Steven W
SW
Boyce
Katrin
K
Leadley
Kevin B
KB
Najarian
Mark S
MS
Slaughter
Francis D
FD
Pagani
D000328:Adult; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000628:therapy; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged