A Device Strategy-Matched Comparison Analysis among Different Intermacs Profiles: A Single Center Experience.

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Medical Devices

Background:

• Left Ventricular Assist Device (LVAD) implantation is a critical intervention for advanced heart failure.
• Patient selection and device strategy significantly influence LVAD outcomes.
• The INTERMACS profile categorizes patient acuity, guiding treatment decisions.

Purpose of the Study:

• To evaluate the outcomes of LVAD patients based on device strategy and INTERMACS profile.
• To compare survival rates and major adverse events across different patient profiles and implantation strategies.
• To identify optimal patient selection criteria for various LVAD implantation strategies.

Main Methods:

• A retrospective study of 192 LVAD patients implanted between January 2012 and May 2021.
• Analysis of primary endpoints (survival) and secondary endpoints (major adverse events).
• Stratification by INTERMACS profiles (1-3 vs. 4) and implantation strategies (Bridge-to-transplant, Bridge-to-candidacy, Destination Therapy).

Main Results:

• Overall 12-month survival was 67%, and 24-month survival was 61%.
• INTERMACS Profile 4 patients demonstrated significantly higher survival rates (p=0.018).
• Profile 1-3 patients experienced higher rates of right-ventricular-failure (RVF), RVAD implantation, CVVH, longer ICU stays, and in-hospital mortality.
• Bridge-to-transplant (BTT) strategy showed better survival than Bridge-to-candidacy (BTC) and Destination Therapy (DT) at 12 and 24 months.

Conclusions:

• Elective LVAD implantation in non-critical patients is associated with improved survival and fewer complications.
• LVAD implantation for Bridge-to-candidacy should be considered before significant patient deterioration.
• Destination Therapy is best suited for elective patients to ensure favorable outcomes.