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The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.

Patient-centered real-world registry analysis of cfLVAD recipients: From survival to freedom from hospitalization and beyond

Published:October 27, 2021DOI:https://doi.org/10.1016/j.healun.2021.10.011
      Cowger and et al.

      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.

      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.
      • Teuteberg JJ
      • Cleveland Jr., JC
      • Cowger J
      • et al.
      The Society of Thoracic Surgeons Intermacs 2019 annual report: the changing landscape of devices and indications.
      ,
      • Stehlik J
      • Kirklin J
      The long and winding road to an effective left ventricular assist device: the demise of Medtronic's HVAD.
      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.

      Abbreviations:

      cfVAD (Continuous flow Ventricular Assist Devices), DOAH (Days Alive Out of the Hospital), PROM (Patient-reported outcome measure), QoL (Quality of life)
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