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Implantation of the Syncardia Total Artificial Heart
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Development of a non-transplant left ventricular assist device program.

Timothy J George1, Allison Aldrich1, Robert L Smith1

  • 1Department of Advanced Heart Failure and MCS, Baylor Scott and White, The Heart Hospital, Plano, Texas, USA.

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A nontransplant center successfully built a destination therapy left ventricular assist device (LVAD) program, demonstrating growth and acceptable outcomes in high-acuity patients. This study highlights the feasibility of expanding LVAD care beyond traditional transplant centers.

Keywords:
transplant

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Area of Science:

  • Cardiology
  • Mechanical Circulatory Support
  • Heart Failure Management

Background:

  • Left ventricular assist device (LVAD) therapy is increasingly used as destination therapy (DT).
  • Outcomes at nontransplant centers performing DT LVADs are less studied.
  • This study evaluates the experience of establishing a nontransplant DT LVAD program.

Purpose of the Study:

  • To assess the feasibility and outcomes of building a destination therapy LVAD program at a nontransplant center.
  • To analyze trends and survival in a cohort of LVAD recipients over time.

Main Methods:

  • Retrospective review of 100 primary LVAD implants from 2010-2021.
  • Analysis of patient, operative, and outcome data, stratified by implant era.
  • Kaplan-Meier survival analysis and multivariable Cox regression.

Main Results:

  • Annual LVAD implant volume increased significantly, with 100 implants performed.
  • 1- and 2-year survival rates were 82% and 79%, respectively.
  • Decreased renal function and longer cardiopulmonary bypass times were associated with higher mortality; preoperative hemoglobin was protective. Later eras showed improved patient acuity and reduced complications.

Conclusions:

  • A single, nontransplant center can achieve substantial growth in LVAD volume.
  • Acceptable outcomes and quality of care can be maintained in a high-acuity patient cohort.
  • This demonstrates the potential for expanding LVAD DT programs at nontransplant facilities.