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Changing trends in mechanical circulatory assistance:
Vivek Rao1, Mehmet C Oz, Margaret A Flannery
1Division of Cardiovascular Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada.
Journal of Cardiac Surgery
|July 13, 2004
Summary
Long-term ventricular assist device (LVAD) use has increased, leading to sicker patients. Despite this, mortality rates for LVAD therapy remain constant, supporting its aggressive use in heart failure.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- Implantable ventricular assist devices (LVADs) are increasingly used for advanced heart failure.
- Patient demographics for LVAD support have shifted towards higher-risk individuals.
- This study examines trends and risk factors in LVAD recipients.
Purpose of the Study:
- To identify emerging risk factors in LVAD patients.
- To analyze changing trends in LVAD recipients over time.
- To evaluate the impact of patient selection on outcomes.
Main Methods:
- Retrospective review of 131 LVAD recipients (HeartMate VE) from 1996-2001.
- Patients stratified into early, mid, and late groups based on time of implantation.
- Preoperative risk scores and perioperative data were analyzed.
Main Results:
- Mean patient risk score significantly increased over time (3.5 to 5.3).
- High-risk patients (score >5) increased from 29% to 51%.
- Operative mortality remained constant at 25%, but hospital stay increased in later groups.
Conclusions:
- LVAD therapy maintains constant mortality despite an increasing high-risk patient profile.
- Duration of support decreased, with a trend towards earlier transplantation.
- Aggressive mechanical support is supported for acute and chronic heart failure.