Defining optimal left ventricular assist device short-term outcomes may provide insight into programmatic quality...

Area of Science:

• Cardiovascular Surgery
• Medical Device Technology
• Health Outcomes Research

Background:

• Significant variability exists in perioperative outcomes following left ventricular assist device (LVAD) implantation.
• A need exists for a comprehensive tool to assess mortality, adverse events (AEs), and patient-reported outcomes for quality improvement.

Purpose of the Study:

• To develop and validate a multidimensional quality score for LVAD recipients.
• To quantify the impact of specific adverse events on mortality and health-related quality of life (QOL).

Main Methods:

• Utilized the Society of Thoracic Surgeons' Intermacs registry data for HeartMate 3 LVAD implants (2017-2024).
• Applied Cox proportional hazard models to derive the INtermacs Short term composITE quality score (INSITE) for mortality.
• Employed logistic regression to assess the impact of AEs on the INSITE-QOL score at 180 days.

Main Results:

• Of 13,148 patients, 33.4% experienced AEs or death within 180 days.
• Specific AEs like stroke, dialysis, respiratory failure, reoperation, and right heart failure significantly increased mortality and decreased QOL.
• Median INSITE and INSITE-QOL scores were 0.0, indicating a need for improvement at many centers.

Conclusions:

• Adverse events following LVAD implantation have a differential and significant impact on both mortality and QOL.
• Center-specific quality improvement initiatives targeting early complication reduction offer the most substantial opportunity to enhance long-term survival and patient QOL.