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Temporal Differences in Outcomes During Long-Term Mechanical Circulatory Support
Simon Maltais1, Lucman A Anwer1, Nicholas A Haglund2
1Mayo Clinic College of Medicine, Rochester, Minnesota.
Insights
Survival after continuous-flow left ventricular assist device (CF-LVAD) implantation remained consistent over time, despite changes in device technology and patient profiles. However, later implantation periods showed increased risks of pump thrombosis and gastrointestinal bleeding.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Outcomes
Background:
- Indications for continuous-flow left ventricular assist device (CF-LVAD) implantation have evolved.
- A multicenter analysis was conducted to assess temporal trends in CF-LVAD outcomes.
Purpose of the Study:
- To evaluate how outcomes after CF-LVAD implantation have changed over time.
- To identify factors influencing survival and adverse events in CF-LVAD patients.
Main Methods:
- Retrospective analysis of 1,064 patients who received CF-LVADs (Heartmate II and Heartware) between 2004 and 2014.
- Patients were divided into three time periods based on technological advancements.
- Adjusted survival and multivariable analyses were performed to identify predictors of mortality and adverse events.
Main Results:
- Device utilization shifted significantly, with increased use of Heartware devices in later periods.
- Adjusted survival rates were similar across all three time intervals.
- Age and Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile were independent predictors of mortality.
- Later periods were associated with a higher risk of pump thrombosis and gastrointestinal bleeding.
Conclusions:
- Post-implantation survival for CF-LVADs has remained stable despite evolving device types and patient populations.
- Patients implanted in more recent periods face an elevated risk of pump thrombosis and gastrointestinal bleeding.
Background:
Device indications have changed for placement of continuous-flow left ventricular assist devices (CF-LVADs). We performed a multicenter analysis evaluating temporal variations in outcomes after CF-LVAD implantation.
Methods & Results:
We retrospectively defined 3 time intervals to reflect changes in CF-LVAD technology (period 1, 2004-2009; period 2, 2010-2012; and period 3, 2012-2014). A total of 1,064 patients (Heartmate II [HMII] = 835; Heartware [HVAD] = 229) underwent CF-LVAD implantation from May 2004 to October 2014. Device utilization was different between periods: period 1: HMII = 134 (100%); period 2: HMII = 480 (88%) and HW = 63 (12%); and period 3: HMII = 221 (57%) and HW = 166 (43%); P < .001. Despite few baseline group differences, adjusted survivals were similar among the time periods (P = .96). Adjusted multivariable analysis revealed age (per 10-year increase) and Interagency Registry for Mechanically Assisted Circulatory Support category (1 vs all others) as the only independent predictors of mortality: P < .001 and P = .008, respectively. Furthermore, it also showed the later periods to be at an increased risk of adverse events: 1) pump thrombosis (periods 2 and 3); and 2) gastrointestinal bleeding (period 3).
Conclusions:
Despite significant differences in device types, indications, and patient characteristics, post-implantation survivals were similar across time intervals. The most recent cohort seems to be at an increased risk of gastrointestinal bleeding and pump thrombosis.
