Cowger and et al.
1
examine the results of cfLVAD implantation as a means to understand how to improve
outcomes of mechanical circulatory support (MCS), and especially avoid vexing and
futile implantations that potentially diminish the awareness of the clinical and social
utility of durable MCS. The advances in the cfLVAD technology have resulted in a paradigm
shift from axial flow (AF) to magnetically levitated (ML) centrifugal flow, which
is evident from this large registry analysis. However, most of the long-term cohort
(87%) had AF devices, and none had ML devices (due to the unavailability of long-term
ML data). Considering the significantly improved post-implant adverse event profile
of ML cfLVADs, their use has been increasing in the last couple of years for both
BTT and DT, the AF cfLVAD is less commonly used, and the hydrodynamically levitated
(HL) cfLVAD no longer manufactured.
Hariri IM, Dardas T, Kanwar M, et al. Long-term survival on LVAD support: Device complications and end-organ dysfunction limit long-term success. J Heart Lung Transplant. 2021 Jul 24:S1053-2498(21)02413-X. https://doi.org/10.1016/j.healun.2021.07.011. Epub ahead of print. PMID: 34404571.
2
,3
The current study demonstrates that quality of life (QOL) after implant is impacted
predominantly by cfLVAD related complications, which eventually lead to poor survival
in the long-term support cohort predominantly consisting of AF cfLVAD patients. However,
it is likely that the reduced probability of cfLVAD complications with the newer ML
cfLVAD, both quality of life (QOL) and long-term survival will further improve. The
VAD complications are a time dependent cumulative process. This study has appropriately
limited the adverse event dependent long-term survival analysis to adverse events
occurring less than 1 year, providing more predictability to long-term success based
on early adverse events.- Stehlik J
- Kirklin J
The long and winding road to an effective left ventricular assist device: the demise
of Medtronic's HVAD.
Circulation. 2021; https://doi.org/10.1161/CIRCULATIONAHA.121.056027
Abbreviations:
cfVAD (Continuous flow Ventricular Assist Devices), DOAH (Days Alive Out of the Hospital), PROM (Patient-reported outcome measure), QoL (Quality of life)To read this article in full you will need to make a payment
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References
Hariri IM, Dardas T, Kanwar M, et al. Long-term survival on LVAD support: Device complications and end-organ dysfunction limit long-term success. J Heart Lung Transplant. 2021 Jul 24:S1053-2498(21)02413-X. https://doi.org/10.1016/j.healun.2021.07.011. Epub ahead of print. PMID: 34404571.
- The Society of Thoracic Surgeons Intermacs 2019 annual report: the changing landscape of devices and indications.Ann Thorac Surg. 2020; 109: 649-660https://doi.org/10.1016/j.athoracsur.2019.12.005
- The long and winding road to an effective left ventricular assist device: the demise of Medtronic's HVAD.Circulation. 2021; https://doi.org/10.1161/CIRCULATIONAHA.121.056027
- The Society of Thoracic Surgeons Intermacs 2020 annual report.Ann Thorac Surg. 2021; 111 (Epub 2021 Jan 16. PMID:33465365): 778-792https://doi.org/10.1016/j.athoracsur.2020.12.038
- Patient-reported health-related quality of life is a predictor of outcomes in ambulatory heart failure patients treated with left ventricular assist device compared with medical management: results from the ROADMAP Study (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management).Circ Heart Fail. 2017; 10 (PMID:28611126)e003910https://doi.org/10.1161/CIRCHEARTFAILURE.116.003910
- Days alive and out of hospital: validation of a patient- centered outcome for perioperative medicine.Anesthesiology. 2019; 131 (PMID:31094760): 84-93https://doi.org/10.1097/ALN.0000000000002701
- Decision aid implementation among left ventricular assist device programs participating in the DECIDE- LVAD Stepped-Wedge Trial.Med Decis Making. 2020; 40 (PMID:32428430; PMCID: PMC7243463): 289-301https://doi.org/10.1177/0272989X20915227
- Shared decision-making for left ventricular assist devices: rationale and design of a nationwide dissemination and implementation project.Circ Cardiovasc Qual Outcomes. 2021; 14 (Epub 2021 Feb 3. PMID:33530698: PMCID: PMC7887063)e007256https://doi.org/10.1161/CIRCOUTCOMES.120.007256
- An early investigation of outcomes with the new 2018 donor heart allocation system in the United States.J Heart Lung Transplant. 2020; 39: 1-4https://doi.org/10.1016/j.healun.2019.11.002
- “Unintended” Consequences of changes in heart transplant allocation policy: impact on practice patterns.ASAIO J. 2020; 66: 125-127https://doi.org/10.1097/MAT.0000000000001128
- First 5-year multicentric clinical trial experience with the HeartMate 3 left ventricular assist system.J Heart Lung Transplant. 2021; 40 (Epub 2021 Jan 8. PMID:33500187): 247-250https://doi.org/10.1016/j.healun.2021.01.001
Article info
Publication history
Published online: October 27, 2021
Footnotes
Statement of authorship: All the authors listed above take responsibility for the reliability and freedom from bias of the presented data and their discussed interpretation.
Grant support/Source of Funding: none.
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© 2021 International Society for Heart and Lung Transplantation. All rights reserved.
