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Left Ventricular Assist Devices; How Do We Define Success?

Anwer, Lucman A.*,†; Poddi, Salvatore*; Tchantchaleishvili, Vakhtang*; Daly, Richard C.*; Toeg, Hadi*; Strand, Jacob J.; Stulak, John M.*; Maltais, Simon*

doi: 10.1097/MAT.0000000000000894
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Despite the growing acceptance of left ventricular assist device (LVAD) therapy to improve survival and quality of life in heart failure (HF) patients, uncertainties persist regarding the definition of a successful implant. We sought to define an innovative approach to assess success and subsequently compare preoperative variables affecting outcomes. From January 2007 to 2015, 278 patients underwent LVAD implantation. Median age at implant was 62 years and 81% patients were males. Indication for support was bridge-to-transplantation in 36% patients and the etiology of HF was ischemic in 49% patients. Based on clinically relevant and accepted standards, we defined successful LVAD implant as someone who was alive or transplanted at 2 years, had two or less readmissions in the first year, had no major adverse events in the first year, and had a New York Heart Association class of ≤ II at 6 months. Follow-up was obtained for a median of 1.7 years for a total of 605 patient-years-of-support. Based on our criteria, 81/278 (29%) patients were defined as having a successful implant. Univariate predictors of LVAD failure included destination therapy indication (hazard ratio [HR] = 2.11 [1.24, 3.58]), ischemic cardiomyopathy (HR = 1.73 [1.02, 2.94]), and a higher left ventricular ejection fraction (HR = 1.54 [1.07, 2.22]). After multivariable analysis, only destination therapy indication (HR = 2.2 [1.28, 3.78]) was found to be independently predictive of success failure. Despite an overall trend toward improved outcomes on device therapy, our criteria classified only one-third of patients as successful. Continued improvements in AE profiles, appropriate patient selection, and optimal time of implantation, together hold the key to improve outcomes after LVAD therapy.

From the *Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota

Department of General Surgery, University of Illinois at Chicago/Metropolitan Group of Hospitals, Illinois

Department of Palliative Care, Mayo Clinic, Rochester, Minnesota.

Submitted for consideration February 2018; accepted for publication in revised form August 2018.

Disclosure: The authors have no conflicts of interest to report.

Presented at the 63rd Annual American Society for Artificial Internal Organs Conference in Chicago, IL.

Correspondence: Simon Maltais, Department of Cardiovascular Surgery Mayo Clinic, 200 First St SW, Rochester, MN 55905. Email: Maltais.Simon@mayo.edu.

Copyright © 2019 by the American Society for Artificial Internal Organs