Outcomes of Contemporary Continuous Flow Left Ventricular Assist Device Support in Patients with End Stage Heart Failure: A Single Center Experience

Daniel Murninkas 1 Binyamin Ben Avraham 1 Israel Mats 1 Hasin Tal 3 Victor Rubchevsky 2 Miriam Abuhazira 2 Dimitry Golubov 2 Viki Yaari 1 Benjamin Medalion 2 Ran Kornowski 1 Ben Gal Tuvia 1 Dan Aravot 4 Dan Aravot 2 Tuvia Ben Gal 1
1Cardiology Department, Rabin Medical Center, Petah Tikva
2Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva
3Cardiology Department, Shaare Zedek Medical Center, Jerusalem

Background: The rate of implantation of continuous flow-left ventricular assist devices (Cf-LVAD) in appropriate end-stage heart failure patients has increased dramatically. The aim of the present study is to describe our center`s experience over 6 years with 59 Cf-LVADs.

Methods: We analyzed all patients implanted with CF-LVAD as a bridge to transplant (BTT), Bridge to transplantability or as destination therapy (DT) from July 2008 until March 2015. Among the CF-LVAD implantated patients, 43 (73%) were implanted with HeartMate II and 16 (27%) received a Heartware HVAD.

Results: Mean age of the CF-LVAD supported patients was 61.1 years (range 25-74) and 49 (83%) were males. Twenty-three (39%) patients were implanted as BTT, 21 (36%) as bridge to transplantability and 15 (25%) as DT. One patient unexpectedly recovered and the device was explanted. Survival rates (transplanted patients censored as survivors) at 30 days, 6 months, and 1 year were: 93%, 83% and 77%, respectively. One year survival for the CF-LVAD implanted since Jan 2013 has improved to 93%. Fifteen (25%) patients underwent Heart transplantation. Post CF-LVAD implantation RV failure occurred in 17 (29%) patients resulting in prolonged hospitalization in 13 and death in 4 (7%) patients. Device exchange was needed in 2 (3%) patients. Mean duration on LVAD support was 560 days (range 2-1825 days). During the first year post CF-LVAD implantation 14 (24%) patients had an infection, 12 (20%) had a thrombotic event and 6 (10%) had gastrointestinal bleeding. Pump thrombosis occurred in 4 (7%) patients. Overall first year adverse events free ranged 39%. Thirty one patients are supported at this moment and doing well.

Conclusion: Survival of patients supported with Cf-LVAD in overall was good but significantly improved in the contemporary era. The rate of complications is absolutely high but relatively low as compared to recent published reports.

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