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Implantation of Left Ventricular Assist Device (LVAD) in Juvenile Landrace Swine: A LVAD Implantation Model of Pediatric Heart Failure
Published on: January 16, 2026
Clinical outcomes in patients with chronic congestive heart failure who undergo left ventricular assist device
Nicholas C Dang1, Veli K Topkara, Brian T Kim
1Division of Cardiothoracic Surgery, Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, NY 10032 , USA. yn33@columbia.edu
Insights
For patients with chronic congestive heart failure, advanced age, female sex, diabetes, and low albumin predict worse outcomes with left ventricular assist devices (LVADs). Careful risk assessment and nutritional optimization are crucial for improving results in these high-risk individuals.
Area of Science:
- Cardiology
- Medical Devices
- Transplantation
Background:
- Left ventricular assist devices (LVADs) are established for chronic congestive heart failure patients awaiting transplantation.
- Limited research exists on LVAD outcomes specifically within this patient subset.
Purpose of the Study:
- To analyze the outcomes of patients with chronic congestive heart failure who received HeartMate LVADs.
- To identify predictors of early mortality, bridge-to-transplantation success, and post-transplantation survival.
Main Methods:
- A retrospective review of 201 patients receiving HeartMate LVADs between 1996 and 2004.
- Focus on 119 patients with chronic congestive heart failure (diagnosis >6 months).
- Analysis of demographic data, pre-operative device use, laboratory values, early mortality, bridge-to-transplantation rate, and post-transplantation survival.
Main Results:
- Advanced age, female sex, and diabetes independently predicted early mortality.
- Advanced age, female sex, and low preoperative albumin predicted a lower bridge-to-transplantation rate.
- No independent predictors for poor post-transplantation survival or prolonged ICU stay were identified.
- Overall bridge-to-transplantation rate was 81.5%; 5-year post-transplantation survival was 78.4%.
Conclusions:
- In chronic congestive heart failure patients undergoing LVAD therapy, advanced age, female sex, diabetes, and low preoperative albumin are associated with adverse clinical trajectories.
- Emphasizes the need for thorough risk stratification and comprehensive evaluation for elderly, female, and diabetic patients.
- Recommends preoperative nutritional optimization to potentially improve outcomes in high-risk LVAD candidates.
Objective:
The use of left ventricular assist devices as a bridge to transplantation for patients with chronic congestive heart failure is well accepted. However, few studies have examined outcomes solely for these patients. This study details one center's left ventricular assist device experience with this population.
Methods:
Two hundred one patients received HeartMate left ventricular assist devices (Thoratec Corp, Pleasanton, Calif) from January 1, 1996, to April 30, 2004. Of these, 119 (59.2%) had chronic congestive heart failure (diagnosis >6 months) as the primary indication. Outcome parameters included early mortality after left ventricular assist device placement (<30 days), bridge-to-transplantation rate, and posttransplantation survival. Variables examined included patient demographic data; preoperative pacemaker, internal defibrillator, and balloon pump use; and preoperative laboratory values.
Results:
Advanced age, female sex, and diabetes were independent predictors of early death (P = .048, odds ratio 1.879 per 10 years of age, 95% confidence interval 1.005-3.515; P = .002, odds ratio 10.029, 95% confidence interval 2.256-44.583; P = .040, odds ratio 3.974, 95% confidence interval 1.063-14.861). Advanced age, female sex, and low preoperative albumin were independent predictors of poor bridge-to-transplantation rate (P = .029, odds ratio 0.135 per 10 years of age, 95% confidence interval 0.022-0.819; P = .002, odds ratio 0.013, 95% confidence interval 0.001-0.197; P = .023, odds ratio 19.178 per 1 g/dL albumin, 95% confidence interval 1.504-244.598). There were no independent predictors of poor posttransplantation survival and prolonged intensive care unit stay. Overall bridge-to-transplantation rate was 81.5%. The 1-, 3-, 5-, and 7-year posttransplantation survivals were 88.4%, 84.5%, 78.4%, and 76.0%.
Conclusion:
Among patients with chronic congestive heart failure, advanced age, female sex, diabetes, and low preoperative albumin predict poor clinical course. Careful risk stratification and comprehensive evaluation by care providers should be performed for candidates who are female, are elderly, and have diabetes, and preoperative nutritional optimization should be encouraged to enhance patient outcomes.
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