Background
Preoperative variables can predict short term left ventricular assist device (LVAD)
survival, but predictors of extended survival remain insufficiently characterized.
Method
Patients undergoing LVAD implant (2012-2018) in the Intermacs registry were grouped
according to time on support: short-term (<1 year, n = 7,483), mid-term (MT, 1-3 years, n = 5,976) and long-term (LT, ≥3 years, n = 3,015). Landmarked hazard analyses (adjusted hazard ratio, HR) were performed to
identify correlates of survival after 1 and 3 years of support.
Results
After surviving 1 year of support, additional LVAD survival was less likely in older
(HR 1.15 per decade), Caucasian (HR 1.22) and unmarried (HR 1.16) patients (p < 0.05). After 3 years of support, only 3 preoperative characteristics (age, race,
and history of bypass surgery, p < 0.05) correlated with extended survival. Postoperative events most negatively influenced
achieving LT survival. In those alive at 1 year or 3 years, the occurrence of postoperative
renal (creatinine HR MT = 1.09; LT HR = 1.10 per mg/dl) and hepatic dysfunction (AST
HR MT = 1.29; LT HR = 1.34 per 100 IU), stroke (MT HR = 1.24; LT HR = 1.42), infection
(MT HR = 1.13; LT HR = 1.10), and/or device malfunction (MT HR = 1.22; LT HR = 1.46)
reduced extended survival (all p ≤ 0.03).
Conclusions
Success with LVAD therapy hinges on achieving long term survival in more recipients.
After 1 year, extended survival is heavily constrained by the occurrence of adverse
events and postoperative end-organ dysfunction. The growth of destination therapy
intent mandates that future LVAD studies be designed with follow up sufficient for
capturing outcomes beyond 24 months.
Keywords
Abbreviations:
AE (Adverse event), cfLVAD (continuous flow left ventricular assist device), HF (heart failure), Intermacs (Interagency Registry for Assisted Circulatory Support), LT (long term), MT (mid term), STS (Society of Thoracic Surgeons)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 23, 2021
Identification
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