Regional differences in use and outcomes of left ventricular assist devices: Insights from the Interagency Registry for Mechanically Assisted Circulatory Support Registry

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:34

Article

Krim, Selim R.¹  Vivo, Rey P.²  Campbell, Patrick¹  Estep, Jerry D.³  Fonarow, Gregg C.²  Naftel, David C.⁴  Ventura, Hector O.¹ 

[1] Ochsner Clin Fdn, John Ochsner Heart & Vasc Inst, New Orleans, LA 70121 USA

[2] Ahmanson Univ Calif Los Angeles UCLA, Ronald Reagan CLA, Cardiomyopathy Ctr, Med Ctr, Los Angeles, CA USA

[3] Houston Methodist Hosp, Methodist DeBakey Heart & Vasc Ctr, Houston, TX USA

[4] Univ Alabama Birmingham, Dept Surg, Birmingham, AL USA

关键词: continuous-flow;    left ventricular assist device;    INTERMACS;    bridge to transplant;    destination therapy;    mechanical circulatory support;    regions;    outcomes;   

DOI  :  10.1016/j.healun.2015.01.007

来源: Elsevier

【 摘 要 】

BACKGROUND: We examined whether characteristics, implant strategy, and outcomes in patients who receive continuous-flow left ventricular assist devices (CF-LVAD) differ across geographic regions in the United States. METHODS: A total of 7,404 CF-LVAD patients enrolled in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) from 134 participating institutions were analyzed from 4 distinct regions: Northeast, 2,605 (35%); Midwest, 2,210 (30%); West, 973 (13%); and South, 1,616 (22%). RESULTS: At baseline, patients in the Northeast and South were more likely to have INTERMACS risk profiles 1 and 2. A bridge-to-transplant (BTT) strategy was more common in the Northeast (31.7%; West, 18.5%; South, 26.9%; Midwest, 25.5%; p < 0.0001). In contrast, destination therapy (DT) was more likely in the South (40.6%; Northeast, 32.3%; Midwest, 27.3%; West, 27.3%; p < 0.0001). Although all regions showed a high 1-year survival rate, some regional differences in long-term mortality were observed. Notably, survival beyond 1 year after LVAD implant was significantly lower in the South. However, when stratified by device strategy, no significant differences in survival for BTT or DT patients were found among the regions. Finally, with the exception of right ventricular failure, which was more common in the South, no other significant differences in causes of death were observed among the regions. CONCLUSIONS: Regional differences in clinical profile and LVAD strategy exist in the United States. Despite an overall high survival rate at 1 year, differences in mortality among the regions were noted. The lower survival rate in the South may be attributed to patient characteristics and higher use of LVAD as DT. (C) 2015 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

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