The role of Heart Failure Team in managing Mechanical Circulatory Support in a Swiss low-volume institution

BACKGROUND: Outcomes after VAD implantation may be dependent on institutional procedural volume. Specifically, it is claimed that high volumes are associated to better clinical results. This study aims to determine if this procedure is safe even in low-volume center. METHODS: Single center, retrospective cohort study, including Heart Failure consecutive patients who received long-term VAD from 2007 to 2017. Primary outcome was survival to transplant or ongoing MCS at 1-year. Survival analysis was performed using Kaplan-Meier method. RESULTS: Data concerning 50 adult patients were examined; 35 male (70%), mean age 49+/- 8 years. VAD was implanted as BTT in 48 and DT in 2. Devices implanted were: HeartMate II in 18 (36%), HeartWare in 20 (40%), HeartMate III in 12 (24%). Outcomes were: Death in 16 (32%), heart transplant in 24 (48%), uneventful ongoing support 10 (20%). Data were analysed according to pre and post-heart team creation and 2 groups of 25 patients were identified: 2007-2013 (mean INTERMACS level 3.1) and 2014-2017 (mean INTERMACS level 3.9) showing 1-year survival of 56% and 80% respectively. According to the type of device implanted, 3 groups were identified: HMII = 18 (mean INT. level 2.7), HW=20 (mean INT. level 3.3) and HMIII=12 (mean INT. level 3.7), showing survival of 52%, 78% and 91% respectively. CONCLUSIONS: Long term MCS can be implanted at low-volume centers with survival rate not inferior to high volume centers. A Heart team specifically trained in heart failure is probably more important than institutional volume in determining outcomes after VAD implantation.