Long-term follow-up evaluation of readmissions after ventricular assist device implantation: trends and outcomes

With the increasing utilization of left ventricular assist devices (LVADs) as a pivotal treatment option for end-stage heart failure, the rehospitalization of patients equipped with these devices has emerged as a significant issue impacting both quality of life and healthcare costs. This study evaluates readmission trends, predisposing factors, and their effects on survival over a long-term follow-up period for patients undergoing LVAD implantation.

The study included 141 patients who underwent LVAD implantation between 2015 and 2023 and were followed for a minimum of 12 months. We analyzed the reasons for readmission, trends related to the devices, and overall outcomes.

The median duration of LVAD support was 49 months (IQR: 22-60). Overall, 102 patients (72.3%) experienced at least one readmission, with a median of two readmissions per patient (IQR: 0-3). Patients who were readmitted had a significantly higher body mass index (median 26.3 kg/m² vs. 23.4 kg/m², p = 0.003). In the multivariable Cox regression analysis, right ventricular dysfunction was the only factor independently associated with hospital readmission (HR = 1.769, 95% CI: 1.097-2.854, p = 0.019). Other variables-including body mass index, reoperative surgery, male gender, and tricuspid valve intervention-were not significantly associated with readmission. The most frequent causes of readmission were wound or driveline infections (33.7%), arrhythmias (16.9%), and right ventricular failure (11.8%). Long-term survival did not differ significantly between readmitted and non-readmitted patients (p = 0.335). Among device types, HeartMate III demonstrated the best survival outcomes [median 60 (40-60) months].

Although LVAD implantation substantially improves survival in advanced heart failure, hospital readmissions remain common throughout long-term follow-up. Right ventricular dysfunction represents a key determinant of readmission risk, highlighting the importance of optimized perioperative management and vigilant monitoring for right-sided failure. Preventive strategies aimed at early detection of RV dysfunction and driveline complications may further reduce rehospitalizations and improve patient outcomes.