5-year results of a newly implemented mechanical circulatory support program for terminal heart failure patients in a Swiss non-cardiac transplant university hospital

Abstract

Background In Switzerland, long-term circulatory support programs have been limited to heart transplant centers. In 2014, to improve the management of patients with end-stage heart failure not eligible for transplantation, we implemented a left ventricular assist device (LVAD) program for destination therapy at the University Hospital of Basel. Methods We described the program set-up with practical aspects. Patients aged 65 and above with therapy refractory end-stage heart failure without major contraindication for LVAD implantation were included. Younger patients with bridge-to-candidacy profile were also considered. Using the Kaplan-Meier estimate, we retrospectively analyzed the overall survival and freedom from major adverse events after LVAD implantation. We compared our results to internationally reported data. Results Between October 2014 and September 2019, 16 patients received an LVAD in our center. The mean age at implantation was 67.1 years. The mean EuroSCORE II was 24.4% and the median INTERMACS level was 4. Thirteen patients received an LVAD as destination therapy and three patients as bridge-to-candidacy. The overall survival was 87.5 and 70% at 1 and 2 years, respectively. Freedom from stroke was 81.3% at 1 and 2 years. Freedom from device infection was 67.7 and 58.7% at 1 and 2 years, respectively. Freedom from gastrointestinal bleeding was 75 and 56.3% at 1 and 2 years, respectively. Freedom from readmission was 50 and 31.3% and at 6 months and 1 year, respectively. Conclusions The Basel experience demonstrated the possible implementation of an LVAD program for destination therapy or bridge-to-candidacy in a non-transplant comprehensive heart-failure center with midterm survival results and freedom from major adverse events comparable to international registries. Patient selection remains crucial. Trial registration This study was registered on the ClinicalTrials.gov database (NCT04263012).

Cardiac Surgery in Advanced Heart Failure

“…This landmark trial showed that HM3 device treatment in BTT vs. DT study participants (197 vs. 317 patients) was associated with a higher survival rate at 1 year and 2 years after implantation (1 year: 88.8 vs. 81.5%; 2 years: 76.8 vs. 73.2%; respectively) [53]. Corresponding survival data were reported from one larger Swiss CF-LT-MCS cohort where in BTT patients the 1 and 2 year mortality rates were 88.4% and 84.4% at 1 and 2 years, respectively [54], while a DT patients cohort reported 87.5 and 70% survival at 1 and 2 years, respectively (n = 16) [55].…”

Development of a non‐transplant left ventricular assist device program

“…This led us to sequentially add two LVAD coordinators. As most providers involved with advanced heart failure therapies will attest, the LVAD coordinator may be the most important member of the entire LVAD team 24 . Although hard to quantify, our increase in LVAD coordinator bandwidth significantly improved our ability to build the volume of the program while maintaining its quality.…”

“…As most providers involved with advanced heart failure therapies will attest, the LVAD coordinator may be the most important member of the entire LVAD team. 24 Although hard to quantify, our increase in LVAD coordinator bandwidth significantly improved our ability to build the volume of the program while maintaining its quality. Similar to our experience, previous reports have emphasized the need for team collaboration, highlighting the roles of cardiology, surgery, anesthesiology, critical care, nursing, LVAD coordinators, and social work.…”

“…Similar to our experience, previous reports have emphasized the need for team collaboration, highlighting the roles of cardiology, surgery, anesthesiology, critical care, nursing, LVAD coordinators, and social work. 24,[35][36][37][38][39][40]…”

“…16,17,22,23 Finally, there is limited literature on how nontransplant centers develop and grow their mechanical circulatory support (MCS) programs. 24 Therefore, we undertook this study to evaluate our experience building a nontransplant, DT-LVAD center.…”