Left ventricular assist device for end-stage heart failure: results of the first LVAD destination program in the Netherlands

Abstract

PurposeMechanical circulatory support with a continuous-flow left ventricular assist device (LVAD) may be a valuable treatment in end-stage heart failure patients for an extended period of time. The purpose of this study was to evaluate the safety and efficacy of implantation of a continuous-flow LVAD in end-stage heart failure patients within the first destination program in the Netherlands.MethodsA third-generation LVAD was implanted in 16 heart failure patients (age 61 ± 8; 81 % male; left ventricular ejection fraction 20 ± 6 %) as destination therapy. All patients were ineligible for heart transplant. At baseline, 3 and 6 months, New York Heart Association (NYHA) functional class, quality-of-life and exercise capacity were assessed. Clinical adverse events were registered.ResultsSurvival at 30 days and 6 months was 88 and 75 %, respectively. In the postoperative phase, 6 (38 %) patients required continuous veno-venous haemofiltration for renal failure and 2 (13 %) patients required extracorporeal membrane oxygenation because of severe right ventricular failure. During follow-up, NYHA functional class and quality-of-life improved from 3.7 ± 0.1 to 2.3 ± 0.1 and 57 ± 5 to 23 ± 3 at 6 months (P < 0.001), respectively. The 6 min walking distance improved from 168 ± 42 m to 291 ± 29 m at 6 months (P = 0.001).ConclusionContinuous-flow LVAD therapy is a promising treatment for patients with end-stage heart failure ineligible for heart transplant.

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

“…By depicting the set-up of our program, we sought to provide practical elements for similar-sized centers wishing to implement a mechanical-circulatory-support program for DT. To our knowledge, only a few center’s experience of establishing an LVAD-program are available with long-term results in the literature, and none specifically for DT [ 16 – 21 ]. Those available with long-term results usually concerned older-generation devices with different implantation strategies from those in our study (i.e.…”

Haemolysis as a first sign of thromboembolic event and acute pump thrombosis in patients with the continuous-flow left ventricular assist device HeartMate II

“…Left ventricular assist devices (LVADs) have increasingly become part of the arsenal in the treatment of end-stage heart failure [ 1 – 3 ]. Despite advances in pump technology, thromboembolic events and acute pump thrombosis remain potentially life-threatening complications [ 4 – 6 ].…”

Clinical outcomes of inpatient cardiac rehabilitation for patients with treated left ventricular assist device in Korea: 1-year follow-up

“…One study (Haeck et al, 2015) reported a survival rate of 75% at 6 months, and the eighth INTERMACS report (all indications, n=15,000) showed that actuarial 1-year survival for continuous-flow LVADs was 80% (Kirklin et al, 2017). The survival rate in the present study was slightly higher than in a previous study (Haeck et al, 2015; Nakatani et al, 2017) and the INTERMACS report (Kirklin et al, 2017), but the small sample size should be considered in comparing survival rates. The most common cause of death was a neurological disorder, followed by multiple system organ failure, infection, device malfunction, and right heart failure (Kirklin et al, 2017).…”

“…The quality of life has become an important parameter in evaluating clinical outcomes in LVAD recipients. Several studies (Haeck et al, 2015; Kato et al, 2015; Kirklin et al, 2017; Mahfood Haddad et al, 2017) demonstrated that quality of life after implantation was significantly improved in the physical and mental components. In our study, the quality of life measured at 12 months using the Minnesota Living with Heart Failure Questionnaire after implantation also showed improvement in both physical and mental components.…”