Identification of Long-Term Mortality Predictors and Risk Score Development in Left Ventricular Assist Device Recipients

Objective: Long-term mortality remains a significant concern in patients receiving left ventricular assist devices (LVADs). Identifying reliable prognostic factors and developing a validated risk score could improve patient selection and long-term management. Methods: In this retrospective single-center study, 35 patients who underwent LVAD implantation between August 2019 and May 2025 were evaluated. Patients who died during the index hospitalization were excluded. Baseline clinical, laboratory, echocardiographic, and hemodynamic parameters were collected. Long-term mortality predictors were identified using Cox regression analyses. A risk score (CACA score) was developed based on significant predictors. Results: Four variables – age, prior coronary artery bypass grafting (CABG), creatinine, and albumin levels – were associated with long-term mortality in univariate analysis. Among these, only age remained an independent predictor in multivariate analysis (hazard ratio HR: 1.48; 95% CI: 1.03–2.12; p=0.032). The CACA risk score was derived using the β-coefficients from multivariate analysis. Patients were stratified into low, intermediate, and high-risk groups with corresponding mortality rates of 0%, 45.4%, and 75%, respectively. The CACA score demonstrated superior discriminative ability compared to individual variables (area under the curve: 0.88). Conclusion: Age, prior CABG, renal function, and albumin levels are key predictors of long-term mortality in LVAD recipients. The proposed CACA score effectively stratifies mortality risk and may serve as a practical tool for clinical decision-making.