Quality of life and functional status in patients surviving 12 months after left ventricular assist device implantation

Allen, Jeremiah G.; Weiss, Eric S.; Schaffer, Justin M.; Patel, Nishant D.; Ullrich, Susan L.; Russell, Stuart D.; Shah, Ashish S.; Conte, John V.

doi:10.1016/j.healun.2009.07.017

« Previous Next »The Journal of Heart and Lung Transplantation
Volume 29, Issue 3 , Pages 278-285, March 2010

Quality of life and functional status in patients surviving 12 months after left ventricular assist device implantation

Jeremiah G. Allen, MD
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins University Medical Institutions, Baltimore, Maryland
Eric S. Weiss, MD
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins University Medical Institutions, Baltimore, Maryland
Justin M. Schaffer, MS
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins University Medical Institutions, Baltimore, Maryland
Nishant D. Patel, BA
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins University Medical Institutions, Baltimore, Maryland
Susan L. Ullrich, RN
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins University Medical Institutions, Baltimore, Maryland
Stuart D. Russell, MD
- Division of Cardiology, Department of Medicine, The Johns Hopkins University Medical Institutions, Baltimore, Maryland
Ashish S. Shah, MD
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins University Medical Institutions, Baltimore, Maryland
John V. Conte, MD
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins University Medical Institutions, Baltimore, Maryland
- Reprint requests: John V. Conte, MD, Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins University Medical Institutions, 600 North Wolfe Street, Blalock 618, Baltimore, MD 21287. Telephone: 410-955-1753. Fax: 410-955-3809

published online 19 October 2009.

Background

As left ventricular assist device (LVAD) support duration increases, quality of life (QoL) becomes a concern. We reviewed the QoL in patients on LVAD support for ≥1 year.

Methods

We retrospectively reviewed our prospective database for patients supported ≥1 year by HeartMate pulsatile- (HM1) or continuous-flow (HM2) LVADs from 2000 to 2009. Transplant or death before 1 year merited exclusion. Metabolic equivalents of tasks (METs), the Minnesota Living with Heart Failure Questionnaire (MLHFQ), the 6-minute walk distance (6MWD), and New York Heart Association (NYHA) class were reviewed. Complications and re-admissions were assessed.

Results

Thirty patients were supported for ≥1 year (7 HM1s, 23 HM2s). Mean support duration was 594 ± 173 days. Mean QoL metrics/functional status indicators at 12 months were: 6MWD, 393 ± 290 m; MET tolerance, 3.3 ± 1; MLHFQ, 35 ± 31; and NYHA, 1.4 ± 0.6. Mean re-admissions/year was 2.9 ± 2, with a duration of 13.8 ± 21 days. Three patients were never re-admitted. Mean out-of-hospital time was 471 ± 172 days (87.3% of days). Infectious complications led to 43% of re-admissions and occurred in the: drive-line (47%) at 442 ± 236 days; blood (37%) at 472 ± 257 days; and LVAD pocket (20%) at 550 ± 202 days. Twenty-three patients (77%) required additional operations (1.7 ± 1.8/year). The most common indication was drive-line infection, but ranged from ischemic bowel to defibrillator exchange. Eight required LVAD exchanges for mechanical (n = 4), electrical (n = 3), and thrombotic (n = 1) issues.