Long-term survival on LVAD support: Device complications and end-organ dysfunction limit long-term success.
Long-term survival on LVAD support: Device complications and end-organ dysfunction limit long-term success.
- 2022
BACKGROUND: Preoperative variables can predict short term left ventricular assist device (LVAD) survival, but predictors of extended survival remain insufficiently characterized. 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. Copyright (c) 2021 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved. 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).
English
1053-2498
*Heart Failure/th [Therapy]
*Heart-Assist Devices/ae [Adverse Effects]
*Multiple Organ Failure/mo [Mortality]
*Registries
Equipment Failure
Female
Follow-Up Studies
Heart Failure/mo [Mortality]
Humans
Male
Middle Aged
Multiple Organ Failure/et [Etiology]
Retrospective Studies
Survival Rate/td [Trends]
Time Factors
United States/ep [Epidemiology]
MedStar Heart & Vascular Institute
Journal Article
BACKGROUND: Preoperative variables can predict short term left ventricular assist device (LVAD) survival, but predictors of extended survival remain insufficiently characterized. 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. Copyright (c) 2021 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved. 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).
English
1053-2498
*Heart Failure/th [Therapy]
*Heart-Assist Devices/ae [Adverse Effects]
*Multiple Organ Failure/mo [Mortality]
*Registries
Equipment Failure
Female
Follow-Up Studies
Heart Failure/mo [Mortality]
Humans
Male
Middle Aged
Multiple Organ Failure/et [Etiology]
Retrospective Studies
Survival Rate/td [Trends]
Time Factors
United States/ep [Epidemiology]
MedStar Heart & Vascular Institute
Journal Article