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Use of Durable Continuous-Flow Ventricular Assist Devices in Patients on Immunosuppression

Sorabella, Robert A.; Han, Jiho; Topkara, Veli K.; Garan, A. Reshad; Yuzefpolskaya, Melana; Colombo, Paolo C.; Takeda, Koji; Naka, Yoshifumi; Takayama, Hiroo
doi: 10.1097/MAT.0000000000000653
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Durable ventricular assist device (VAD) therapy remains an important treatment for end-stage heart failure. Despite advancements in device design, postimplant infectious complications continue to plague this population. In this study, we aim to evaluate the use of durable VAD therapy in patients on active immunosuppression. All patients undergoing durable, continuous-flow VAD placement on active immunosuppression at our center from 2004 to 2012 were included in the analysis (group immunosuppressed [IS]; n = 13). Demographic data, comorbidities, device details, immunosuppression details including indication, postimplant infections, and outcomes were collected and compared with patients without immunosuppression (group non-IS; n = 259). Mean age in the IS group was 56.3 ± 12.4 years, and 12 patients (92.3%) were male. Twelve patients (92.3%) were implanted as a bridge to transplant. Incidence of any postimplant infection and device-related infection was 1.15 infections/patient × year and 0.38 infections/patient × year, respectively. Survival to discharge was 84.6% and 93.1% (p = 0.25), and 1 year survival was 75.0% and 83.1% (p = 0.47) in the IS and non-IS group, respectively. Mean duration of support was 384 ± 466 days, and mean follow-up was 2.1 ± 1.5 years. Active immunosuppression may lead to a modest increase in postimplant infection rate in durable VAD patients than in non-IS patients undergoing the same treatment; however, late on-device survival is not affected. Immunosuppression should not be considered an absolute contraindication to device implant.

Submitted for consideration March 2017; accepted for publication in revised form August 2017.

Robert A. Sorabella and Jiho Han are co-first authors.

Disclosure: Yoshifumi Naka is a consultant for Abbott Laboratories. The remaining authors have no conflicts of interest to report.

Correspondence: Hiroo Takayama, MD, PhD, Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, 177 Fort Washington Ave., Milstein Hospital Building, 7GN-435, New York, NY 10032. Email: ht2225@cumc.columbia.edu.

Copyright © 2017 by the American Society for Artificial Internal Organs