What question did this study set out to answer?

To evaluate clinical outcomes, survival rates, and complication profiles in patients receiving newer-generation left ventricular assist devices for refractory advanced heart failure.

August 24, 2023Internal Medicine JournalOpen Access

Left ventricular assist devices for treatment of refractory advanced heart failure: the Western Australian experience

View Full Paper

Ask AI

Bookmark

Why the study?

LVADs can prolong survival and improve quality of life in end-stage heart failure, prompting a review of outcomes from the Western Australian LVAD programme.

Key Points

To evaluate clinical outcomes, survival rates, and complication profiles in patients receiving newer-generation left ventricular assist devices for refractory advanced heart failure.
Retrospective database and medical record review conducted across a 23-year single-region experience.
Analyzed N=95 patients receiving newer-generation continuous-flow devices (HeartWare HVAD, HeartMate II, and HeartMate 3) as bridge-to-transplantation/candidacy (94%) or destination therapy (6%).
Survival with the device in situ was 94% at 1 year, 88% at 2 years, and 62% at 5 years, with 96% surviving to initial hospital discharge.
Post-discharge patients spent 98% of days out of the hospital (median 1.5 readmissions per patient-year), with adverse events including infection requiring IV therapy/admission (36%), significant gastrointestinal bleeding (19%), and stroke (11%).
All destination therapy recipients survived at least 4 years (spending 97% of days as outpatients), including the longest-surviving HVAD destination therapy cases globally (11.3 and 10.5 years).

Structured PICO

Population

95 patients with refractory advanced heart failure receiving newer-generation LVADs (HeartWare HVAD, HeartMate II, HeartMate 3). 94% bridge-to-transplant/candidacy/decision, 6% destination therapy. Mean LVEF 20%, 36% severe RV dysfunction, 62% nonischaemic cardiomyopathy.

Intervention

Implantation of newer-generation left ventricular assist devices (HeartWare HVAD, HeartMate II, HeartMate 3)

Outcome

Survival with LVAD in situ at 1, 2, and 5 yearshard clinical

Newer-generation LVADs demonstrate excellent long-term survival (62% at 5 years) and high outpatient time in patients with refractory advanced heart failure.

Implication

Single-centre retrospective LVAD data support local programme feasibility; leaves open generalizability and need for prospective validation.

Abstract

BACKGROUND: Left ventricular (LV) assist devices (LVADs) can prolong survival and improve quality of life in end-stage heart failure. AIMS: Review outcomes of the Western Australian LVAD programme. METHODS: Retrospective database and medical record review. RESULTS: One hundred forty-seven LVADs have been implanted in 23 years, of which 95 were newer-generation devices (HeartWare HVAD [HW], HeartMate II and HeartMate 3). Presented data refer to these devices only. Most patients (94%) were classed as bridge-to-transplant or -candidacy/decision, with the remainder classed as 'destination therapy' (DT). Mean LV ejection fraction was 20%, and 36% had severe right ventricular dysfunction. Sixty-two percent of patients had a nonischaemic cardiomyopathy. Following LVAD implant, the median length of stay in intensive care was 2 days, and in the hospital overall was 23 days. Ninety-six percent of patients survived to hospital discharge, and, following discharge, 98% of days with LVAD were spent as an outpatient. The median number of hospital readmissions was 1.5 per patient per year. LVAD-associated infection requiring admission or intravenous antibiotics at any time after implant occurred in 36%, significant gastrointestinal bleeding in 19% and stroke in 11%. The percentage of patients alive with LVAD still in situ at 1, 2 and 5 years was 94%, 88% and 62% respectively, which exceeds current international registry outcomes. All DT patients survived at least 4 years, spending 97% of days with LVAD as an outpatient. The two longest-surviving HW DT patients worldwide (11.3 and 10.5 years) are among this cohort. CONCLUSIONS: Excellent outcomes can be achieved with LVADs in appropriately selected patients.