Left ventricular assist devices: How do we define success?

Lucman A. Anwer, Salvatore Poddi, Vakhtang Tchantchaleishvili, Richard C. Daly, Hadi Toeg, Jacob J. Strand, John M. Stulak, Simon Maltais

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Despite the growing acceptance of left ventricular assist device (LVAD) therapy to improve survival and quality of life in heart failure (HF) patients, uncertainties persist regarding the definition of a successful implant. We sought to define an innovative approach to assess success and subsequently compare preoperative variables affecting outcomes. From January 2007 to 2015, 278 patients underwent LVAD implantation. Median age at implant was 62 years and 81% patients were males. Indication for support was bridge-to-transplantation in 36% patients and the etiology of HF was ischemic in 49% patients. Based on clinically relevant and accepted standards, we defined successful LVAD implant as someone who was alive or transplanted at 2 years, had two or less readmissions in the first year, had no major adverse events in the first year, and had a New York Heart Association class of ≤ II at 6 months. Follow-up was obtained for a median of 1.7 years for a total of 605 patient-years-of-support. Based on our criteria, 81/278 (29%) patients were defined as having a successful implant. Univariate predictors of LVAD failure included destination therapy indication (hazard ratio [HR] = 2.11 [1.24, 3.58]), ischemic cardiomyopathy (HR = 1.73 [1.02, 2.94]), and a higher left ventricular ejection fraction (HR = 1.54 [1.07, 2.22]). After multivariable analysis, only destination therapy indication (HR = 2.2 [1.28, 3.78]) was found to be independently predictive of success failure. Despite an overall trend toward improved outcomes on device therapy, our criteria classified only one-third of patients as successful. Continued improvements in adverse event profiles, appropriate patient selection, and optimal time of implantation, together hold the key to improve outcomes after LVAD therapy.

Original languageEnglish (US)
Pages (from-to)430-435
Number of pages6
JournalASAIO Journal
Volume65
Issue number5
DOIs
StatePublished - Jan 1 2019

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Keywords

  • Criteria
  • Left ventricular assist device
  • Successful LVAD

ASJC Scopus subject areas

  • Biophysics
  • Bioengineering
  • Biomaterials
  • Biomedical Engineering

Cite this

Anwer, L. A., Poddi, S., Tchantchaleishvili, V., Daly, R. C., Toeg, H., Strand, J. J., Stulak, J. M., & Maltais, S. (2019). Left ventricular assist devices: How do we define success? ASAIO Journal, 65(5), 430-435. https://doi.org/10.1097/MAT.0000000000000894