Trends in long‐term mechanical circulatory support for advanced heart failure in the UK

Emin, A; Rogers, Chris; Parameshwar, Jayan; MacGowan, Guy A.; Taylor, Rhiannon; Yonan, Nizar; Simon, Andrè; Tsui, Steven; Schueler, Stephan; Banner, Nicholas R.; Forum, UK Vad

doi:10.1093/eurjhf/hft127

Cited by 30 publications

(28 citation statements)

References 15 publications

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“…Emin et al [5] have recently published outcomes in the UK demonstrating improvements in survival over time with newer generation devices, and the results from this study reflect this improved survival. When compared with the INTERMACS registry outcomes, the results are slightly worse than the BTT outcomes (censored at transplantation), but very similar to the DT outcomes, and this difference is likely due to the availability of transplantation [6].…”

Section: Discussionsupporting

confidence: 68%

“…In this setting, the UK is unique, with a striking fall in numbers of heart transplants and no prioritization of these patients. In the UK, the rate of bridging to transplantation is about 5 and 10% at 6 and 12 months, respectively [5]. The consequence of this low rate of transplantation is that those patients with device-related complications will not have access to timely transplantation, thereby potentially increasing the rate of adverse outcomes including death on the device.…”

Section: Introductionmentioning

confidence: 99%

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Four-year outcomes with third-generation centrifugal left ventricular assist devices in an era of restricted transplantation

Özalp

Bhagra

et al. 2014

European Journal of Cardio-Thoracic Surgery

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OBJECTIVESThird-generation ventricular assist devices (VADs) are associated with improved outcomes, though in recent clinical trials bridge-to-transplant (BTT) rates are ∼30% at 6 months, so that transplantation can be used as a ‘bail out’ for serious complications. In the UK, there was a significant reduction in heart transplantation rates over the last decade, so that transplantation from VADs is much less frequent. The objective of this study was to determine outcomes and their predictors in this situation of low BTT rates, and as patients were exposed to long-term support, the incidence and outcomes of VAD thrombosis.METHODSWe analysed outcomes for 102 consecutive patients between 2009 and 2013 (mean age 47 ± 13; VentrAssist n = 6 and HeartWare n = 96). The median duration of support was 462 ± 426 days.RESULTSSurvival rates on the device were 75 and 66% at 1 and 2 years, respectively. Older age and more acute INTERMACS groups were significantly related to reduced survival within the first 90 days (P = 0.030 and 0.010, respectively). Poor preoperative right ventricular (RV) function had a negative effect on survival after 1 year (P = 0.009), though not earlier. VAD thrombosis (n = 24 HeartWare and n = 1 VentrAssist) occurred at 0.18 events per patient-year for HeartWare and 0.07 for VentrAssist devices at a median time of onset at 404 ± 281 days. There was no significant effect of VAD thrombosis on survival. Only 14 of 102 patients were transplanted at a median of 334 ± 347 days, and only 3 were transplanted within the first 6 months.CONCLUSIONSThird-generation left ventricular assist device implants with a low rate of transplantation have similar survival to destination therapy, and are susceptible to long-term complications of VAD thrombosis and right heart failure.

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Section: Discussionsupporting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Four-year outcomes with third-generation centrifugal left ventricular assist devices in an era of restricted transplantation

Özalp

Bhagra

et al. 2014

European Journal of Cardio-Thoracic Surgery

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“…AMCS devices are expensive [9, 19, 20] and this, coupled with a potentially prolonged length of stay in ICU, means that cost is an important factor in the decision-making process, particularly within the UK NHS. Indeed, decision-makers have opted to centralise AMCS funding to a restricted number of the larger cardiothoracic centres [21], invariably depriving other units of this potentially life-saving resource.…”

Section: Discussionmentioning

confidence: 99%

A 20-year multicentre outcome analysis of salvage mechanical circulatory support for refractory cardiogenic shock after cardiac surgery

Khorsandi

Dougherty

Sinclair

et al. 2016

J Cardiothorac Surg

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BackgroundRefractory post-cardiotomy cardiogenic shock (PCCS) is a relatively rare phenomenon that can lead to rapid multi-organ dysfunction syndrome and is almost invariably fatal without advanced mechanical circulatory support (AMCS), namely extra-corporeal membrane oxygenation (ECMO) or ventricular assist devices (VAD). In this multicentre observational study we retrospectively analyzed the outcomes of salvage venoarterial ECMO (VA ECMO) and VAD for refractory PCCS in the 3 adult cardiothoracic surgery centres in Scotland over a 20-year period.MethodsThe data was obtained through the Edinburgh, Glasgow and Aberdeen cardiac surgery databases. Our inclusion criteria included any adult patient from April 1995 to April 2015 who had received salvage VA ECMO or VAD for PCCS refractory to intra-aortic balloon pump (IABP) and maximal inotropic support following adult cardiac surgery.ResultsA total of 27 patients met the inclusion criteria. Age range was 34–83 years (median 51 years). There was a large male predominance (n = 23, 85 %). Overall 23 patients (85 %) received VA ECMO of which 14 (61 %) had central ECMO and 9 (39 %) had peripheral ECMO. Four patients (15 %) were treated with short-term VAD (BiVAD = 1, RVAD = 1 and LVAD = 2). The most common procedure-related complication was major haemorrhage (n = 10). Renal failure requiring renal replacement therapy (n = 7), fatal stroke (n = 5), septic shock (n = 2), and a pseudo-aneurysm at the femoral artery cannulation site (n = 1) were also observed. Overall survival to hospital discharge was 40.7 %. All survivors were NYHA class I-II at 12 months’ follow-up.ConclusionAMCS for refractory PCCS carries a survival benefit and achieves acceptable functional recovery despite a significant complication rate.

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“…1,[4][5][6] Continuous flow LVADs have proven their reliability in relation to outcome following elective surgery in chronic heart failure patients before the onset of cardiogenic shock. 7) In patients up to 70 years of age without cardiogenic shock, diabetes and renal failure, circulatory support with a continuous flow LVAD showed 1-and 2-year survival of 80% and 70%, which was comparable with heart transplantation.…”

Section: Discussionmentioning

confidence: 99%

A UK Single Centre Retrospective Analysis of the Relationship between Haemodynamic Changes and Outcome in Patients Undergoing Prolonged Left Ventricular Assist Device Support

Capoccia

Bowles

Sabashnikov

et al. 2015

ATCS

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IntroductionAlthough heart transplantation remains the gold standard for the treatment of end-stage heart failure with an average 2-year survival rate of 80%, 1) its epidemiological impact is limited by organ availability. 2) Over the last 5 years, rotary left ventricular assist devices (LVADs) have been used increasingly either as a bridge to transplant or for permanent support. In spite of their clinical efficacy, LVADs remain associated with serious complications which compromise outcome. However, the association between changes in haemodynamic parameters during support and outcome remains inadequately Purpose: Despite their efficacy, LVADs remain associated with serious complications. The relationship between haemodynamic changes during support and outcome remains inadequately characterised. This association was investigated in LVAD recipients undergoing prolonged support. Methods: Forty patients receiving LVAD therapy for >2 years were reviewed retrospectively (mean support duration was 38.62 ± 15.28). Pre-and on-LVAD haemodynamic data were assessed in three groups: (1) those receiving ongoing support (n = 24); (2) those who underwent cardiac transplantation (n = 4); (3) those who died during support (n = 12). Results: For group 1 and 2, LVAD support achieved a decrease in mean PAP, mean PCWP, TPG, and PVR and an increase in thermodilution blood flow (TBF) with significance at ≤5% level. For group 3, there were non-significant changes in TPG and PVR at the 5% level but for mean PAP, mean PCWP, and TBF the changes were similar to Groups 1 and 2 with significance at ≤5% level. Aggregated data from all three groups showed a 58% increase in TBF on LVAD support. Conclusion: Highly significant and favourable haemodynamic changes were found. However, group 3 did not undergo decrease in TPG and PVR possibly because of suboptimal LVAD flow, right heart dysfunction and unavoidable prolongation of support.

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Trends in long‐term mechanical circulatory support for advanced heart failure in the UK

Cited by 30 publications

References 15 publications

Four-year outcomes with third-generation centrifugal left ventricular assist devices in an era of restricted transplantation

Four-year outcomes with third-generation centrifugal left ventricular assist devices in an era of restricted transplantation

A 20-year multicentre outcome analysis of salvage mechanical circulatory support for refractory cardiogenic shock after cardiac surgery

A UK Single Centre Retrospective Analysis of the Relationship between Haemodynamic Changes and Outcome in Patients Undergoing Prolonged Left Ventricular Assist Device Support

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