title: Outcomes on Continuous Flow Left Ventricular Assist Devices: A Single Institutional 9-Year Experience.
abstract: BACKGROUND
  Continuous-flow left ventricular assist devices (LVADs) have become the standard of care for patients with advanced heart failure. The goal of this study was to review our 9-year institutional experience.
  
  
  METHODS
  From March 2006 through May 2015, 231 patients underwent implantation of 240 CF LVADs, HeartMate II LVAD (Thoratec Corp., Pleasanton, CA; n = 205) or HVAD (HeartWare Inc., Framingham, MA; n = 35). Of these, 127 devices (52.9%) were implanted as bridge to transplantation (BTT) and 113 (47.1%) as destination therapy (DT).
  
  
  RESULTS
  Mean age was 51.2 ± 11.9 years for BTT patients and 58.2 ± 11.4 years for DT patients (p < 0.001). There was a higher incidence of preoperative diabetes, renal insufficiency, peripheral vascular disease, and previous cardiac operation in DT patients (p < 0.05). Survival was higher for BTT patients, with 1-, 6-, 12-, and 24-month survivals of 91.0%, 90.0%, 88.5%, and 72.1%, respectively, versus 85.3%, 81.1%, 75.6%, and 59.0%, respectively, for DT patients (p = 0.038). Gastrointestinal bleeding was the most common complication (29.6%), followed by right ventricular failure (22.5%) and stroke (15.0%), with a similar incidence for BTT and DT patients. Preoperative liver biopsy (hazard ratio [HR] 2.27, p = 0.036), mechanical support (HR 1.82, p = 0.025), aspartate transaminase (HR 1.07, p = 0.001), and alanine aminotransferase (HR 0.95, p = 0.024) were severe independent predictors of survival in multivariate analysis.
  
  
  CONCLUSIONS
  These data indicate excellent survival for BTT and DT patients on long-term LVAD support. However, for LVAD therapy to become a plausible alternative to heart transplantation, we need to further decrease the incidence of postoperative complications.
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan. Electronic address: jamorganmd@hotmail.com.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Morgan
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan.
authors.forename: Pauline H
authors.initials: PH
authors.lastname: Go
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan.
authors.forename: Linnea
authors.initials: L
authors.lastname: Xuereb
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan.
authors.forename: Babbaljeet
authors.initials: B
authors.lastname: Kaur
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan.
authors.forename: Silvy
authors.initials: S
authors.lastname: Akrawe
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan.
authors.forename: Hassan W
authors.initials: HW
authors.lastname: Nemeh
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan.
authors.forename: Jamil
authors.initials: J
authors.lastname: Borgi
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan.
authors.forename: David E
authors.initials: DE
authors.lastname: Lanfear
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan.
authors.forename: Celeste T
authors.initials: CT
authors.lastname: Williams
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paone
mesh_terms: D000328:Adult; D016208:Databases, Factual; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D006353:Heart-Assist Devices / Q000706:statistics & numerical data*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D015999:Multivariate Analysis; D061646:Operative Time; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome