Long-term survival on LVAD support: Device complications and end-organ dysfunction limit long-term success

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:41

Article

Hariri, Imad M.¹  Dardas, Todd²  Kanwar, Manreet³  Cogswell, Rebecca⁴  Gosev, Igor⁵  Molina, Ezequiel⁶  Myers, Susan L.⁷  Kirklin, James K.⁷  Shah, Palak⁸  Pagani, Francis D.⁹  Cowger, Jennifer A.¹ 

[1] Henry Ford Hosp, Detroit, MI 48220 USA

[2] Univ Washington, Seattle, WA 98195 USA

[3] Allegheny Hlth Network, Pittsburgh, PA USA

[4] Univ Minnesota, Minneapolis, MN USA

[5] Univ Rochester, Rochester, NY USA

[6] MedStar Washington Hosp Ctr, MedStar Heart & Vasc Inst, Washington, DC USA

[7] Univ Alabama Birmingham, Birmingham, AL USA

[8] Inova Heart & Vasc Inst, Falls Church, VA USA

[9] Univ Michigan, Cardiovasc Ctr, Ann Arbor, MI 48109 USA

关键词: LVAD;    survival;    risk factors;    complications;   

DOI  :  10.1016/j.healun.2021.07.011

来源: Elsevier

【 摘 要 】

BACKGROUND: Preoperative variables can predict short term left ventricular assist device (LVAD) survival, but predictors of extended survival remain insufficiently characterized. METHOD: Patients undergoing LVAD implant (2012-2018) in the Intermacs registry were grouped according to time on support: short-term (<1 year, n = 7,483), mid-term (MT, 1-3 years, n = 5,976) and long-term (LT, >= 3 years, n = 3,015). Landmarked hazard analyses (adjusted hazard ratio, HR) were performed to identify correlates of survival after 1 and 3 years of support. RESULTS: After surviving 1 year of support, additional LVAD survival was less likely in older (HR 1.15 per decade), Caucasian (HR 1.22) and unmarried (HR 1.16) patients (p < 0.05). After 3 years of support, only 3 preoperative characteristics (age, race, and history of bypass surgery, p < 0.05) correlated with extended survival. Postoperative events most negatively influenced achieving LT survival. In those alive at 1 year or 3 years, the occurrence of postoperative renal (creatinine HR MT = 1.09; LT HR = 1.10 per mg/dl) and hepatic dysfunction (AST HR MT = 1.29; LT HR = 1.34 per 100 IU), stroke (MT HR = 1.24; LT HR = 1.42), infection (MT HR = 1.13; LT HR = 1.10), and/or device malfunction (MT HR = 1.22; LT HR = 1.46) reduced extended survival (all p <= 0.03). CONCLUSIONS: Success with LVAD therapy hinges on achieving long term survival in more recipients. After 1 year, extended survival is heavily constrained by the occurrence of adverse events and postoperative end-organ dysfunction. The growth of destination therapy intent mandates that future LVAD studies be designed with follow up sufficient for capturing outcomes beyond 24 months. (C) 2021 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

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