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Impact of Patient Distance From Ventricular Assist Device–Implanting Center on Short- and Long-Term Outcomes

Ravichandran, Ashwin K.*; Shah, Palak; Singh, Ramesh; Aaronson, Keith D.; Pagani, Francis D.; Stulak, John§; Dunlay, Shannon M.§; Dardas, Todd F.; Mokadam, Nahush A.; Salerno, Christopher T.*; Cowger, Jennifer A.*

doi: 10.1097/MAT.0000000000000717
Adult Circulatory Support

Highly specialized left ventricular assist device care is not readily available in many areas, potentially limiting access to therapy. This retrospective analysis examines the relationship of outcomes by patient distance from implanting left ventricular assist device center within the Mechanical Circulatory Support Research Network. Zip codes were used to calculate patient distance, with the primary outcome of interest being 3-year survival by distance from the surgical center. Secondary outcomes included 90-day survival and incident event rates for the following: gastrointestinal bleeding, infection, cerebral event, and pump thrombosis. Across the four centers, there were 1184 patients supported for a median of 486 days. Overall survival was 91 ± 0.8% at 90 days and 61 ± 1.9% at 3 years, with worse 3-year survival in those living >90 vs. ≤90 miles from the ventricular assist device implant center (55 ± 3.0% vs. 64 ± 2.5, p = 0.019). Patients living >90 miles from an implant center were older, more likely to be implanted for destination therapy support, had a prior sternotomy, and had worse renal function than those living closer (p <0.05 for all). After adjusting for these factors, albumin and center of implant, the hazard ratio did not reach statistical significance (hazard ratio = 1.2; p = 0.14). Except for gastrointestinal bleeding, the event rates for the secondary outcomes were higher for those living closer to the implanting center. Protocols should be designed for more frequent follow-up and increased shared care opportunities to ensure optimal outcomes are achieved in distant patients.

From the *St. Vincent Heart Center of Indiana, Indianapolis, Indiana

Inova Heart and Vascular Institute, Falls Church, Virginia

University of Michigan Health System, Ann Arbor, Michigan

§Mayo Clinic, Rochester, Minnesota

University of Washington Medical Center, Seattle, Washington.

Submitted for consideration May 2017; accepted for publication in revised form October 2017.

Disclosures: Ashwin Ravichandran receives Institutional research funds from Abbott and Medtronic. Palak Shah reports Institutional research from Medtronic and Haemonetics; Keith D. Aaronson reports Institutional research from Abbott and Medtronic. Francis D. Pagani reports Institutional research from Abbott and Medtronic. Todd F. Dardas reports Medtronic/HeartWare, Research grant. Nahush A. Mokadam reports Consultant for Medtronic, Abbott; Investigator for Medtronic, Abbott, SynCardia. Christopher T. Salerno reports Institutional research funds from Abbott and Medtronic. Jennifer A. Cowger reports Institutional research funds from Abbott and Medtronic. Travel support for research from Abbott.

Correspondence: Ashwin K. Ravichandran, St. Vincent Heart Center of Indiana, 8333 Naab Rd, Suite 400, Indianapolis, IN 46260. Email: ashwin.ravichandran@ascension.org.

Copyright © 2018 by the American Society for Artificial Internal Organs