Continuous-flow LVADs in the Nordic countries: complications and mortality and its predictors

Abstract

Objectives: The purpose of this study was to assess complications and mortality and its predictors, with continuous-flow left ventricular assist devices (CF-LVADs) in the Nordic Countries. Design: This was a retrospective, international, multicenter cohort study. Results: Between 1993 and 2013, 442 surgically implanted long-term mechanical assist devices were used among 8 centers in the Nordic countries. Of those, 238 were CF-LVADs (HVAD or HeartMate II) implanted in patients >18 years with complete data. Postoperative complications and survival were compared and Cox proportion hazard regression analysis was used to identify predictors of mortality. The overall Kaplan-Meier survival rate was 75% at 1 year, 69% at 2 years and 63% at 3 years. A planned strategy of destination therapy had poorer survival compared to a strategy of bridge to transplantation or decision (2-year survival of 41% vs. 76%, p < .001). The most common complications were non-driveline infections (excluding sepsis) (44%), driveline infection (27%), need for continuous renal replacement therapy (25%) and right heart failure (24%). In a multivariate model age and left ventricular diastolic dimension was left as independent risk factors for mortality with a hazard ratio of 1.35 (95% confidence interval (CI) [1.01-1.80], p ¼ .046) per 10 years and 0.88 (95% CI [0.72-0.99], p ¼ .044) per 5 mm, respectively. Conclusion: Outcome with CF LVAD in the Nordic countries was comparable to other cohorts. Higher age and destination therapy require particularly stringent selection.

Safety and feasibility of hemodynamic pulmonary artery pressure monitoring using the CardioMEMS device in LVAD management

“…The median age was 60 (53-66) years, and 87% of patients were men. The median RA pressure was 5.0 [2.3-9.8], and the median systolic, diastolic, and mean PAP were 35 (28-46), 17 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), and 24 (21-32) mmHg, respectively, at baseline.…”

“…Due to technological improvements and advances in LVAD management, the overall survival of continuous‐flow LVAD patients has improved significantly over the last years, with 1‐year survival rates estimated between 75% and 85%. 2 , 12 , 13 , 14 However, LVAD‐related complications, such as severe RV‐failure, renal failure, and major bleedings events still affect the overall outcome of LVAD patients. 2 Effective strategies to identify and optimize patients at high risk for LVAD complications are urgently needed.…”

Left Ventricular Assist Device Implantation and Concomitant Dor Procedure: a Single Center Experience

“…Documented events were mainly bleeding and renal and respiratory failures. These complications were described extensively for patients with end-stage HF undergoing LVAD implantation [ 15 , 16 ] and are not attributable to the performed Dor plasty.…”