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Improved survival in patients with continuous-flow ventricular assist device for bridge to heart transplantation
M Ono1, T Nishimura, O Kinoshita
1Department of Cardiac Surgery, University of Tokyo, Tokyo, Japan.
Insights
Continuous-flow ventricular assist devices (CFVADs) offer a safe and effective option for patients awaiting heart transplantation (HT). CFVADs improve survival and quality of life for advanced heart failure patients on the bridge to transplantation waiting list.
Area of Science:
- Cardiology
- Medical Devices
- Surgical Technology
Background:
- Contemporary continuous-flow ventricular assist devices (CFVADs) have improved survival for bridge to transplantation (BTT) and destination therapy.
- In Japan, CFVAD use is currently limited to BTT indications.
- Long donor waiting times for heart transplantation (HT) necessitate effective circulatory support.
Purpose of the Study:
- To evaluate the outcomes of CFVADs in patients indicated for bridge to transplantation (BTT).
- To compare the efficacy of CFVADs with traditional paracorporeal pulsatile devices.
- To assess the impact of CFVADs on patient survival and quality of life during the HT waiting period.
Main Methods:
- Retrospective analysis of 89 ventricular assist device (VAD) treatments.
- Comparison between paracorporeal pulsatile Nipro VAD (n=67) and continuous-flow VAD (CFVAD) (n=22) groups.
- Inclusion of patients with preimplantation conditions of profile 1 (n=49) and profile 2 or 3 (n=40), with all CFVAD patients being profile 2 or 3.
Main Results:
- Actuarial survival rates at 1, 3, and 5 years were 81.6%, 69.5%, and 61.1%, respectively.
- CFVAD patients demonstrated superior survival compared to paracorporeal VAD recipients.
- Significant reduction in 6-month mortality from 20% (pre-2009) to 3% (post-2010) was observed.
- All CFVAD patients were discharged alive, with 26 transplanted, 7 weaned, and 27 remaining on support.
Conclusions:
- Contemporary CFVADs provide safe and reliable circulatory support for advanced heart failure patients awaiting HT.
- CFVADs enhance patient quality of life and enable a less critical preimplantation status.
- CFVADs represent the safest and most effective option for long-term VAD support in BTT indications.
Background:
Contemporary continuous-flow ventricular assist devices (CFVADs) have greatly improved patient survival for indications of bridge to transplantation (BTT) and destination therapy. In Japan, CFVAD is limited for BTT use. The waiting period for heart transplantation (HT) is long owing to donor shortage. We examined the results of CFVAD for BTT indication.
Methods:
Eighty-nine VAD treatments were performed among subjects whose preimplantation condition was profile 1 (n = 49) or profile 2 or 3 (n = 40). The device was the paracorporeal pulsatile Nipro VAD (n = 67) or CFVAD (n = 22). All CFVAD patients were profile 2 or 3.
Results:
The median assist period was 529 days (Nipro VAD, 530; CFVAD, 528). Twenty-six patients were on the device for >2 years. Actuarial survival was 81.6%, 69.5%, and 61.1% at 1, 3, and 5 years. Survival in profile 1 was significantly worse than in profile 2 or 3. Survival of CFVAD patients was superior to that of paracorporeal VAD. Six-month mortality rate of 20% in cases before 2009 (n = 60) was dramatically improved to 3% among those after 2010 (n = 29). All patients with CFVAD were alive and discharged home. 26 patients were transplanted, 7 had been weaned from VAD and 27 were on a device. The rate of events requiring hospital admission was 0.98 per patient-year in CFVAD patients.
Conclusions:
Contemporary CFVADs have enabled advanced heart failure patients to await HT safely with an improved quality of life. The advent of CFVAD has also shifted their preimplantation condition to a less sick status. CFVADs were the safest, most reliable circulatory support devices for long-term waiting periods for the BTT indications.
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