Temporal Differences in Outcomes During Long-Term Mechanical Circulatory Support

Simon Maltais, Lucman A. Anwer, Nicholas A. Haglund, Jennifer Cowger, Palak Shah, Keith D. Aaronson, Francis D. Pagani, Shannon M. Dunlay, Ramesh Singh, Christopher T. Salerno, John M. Stulak

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Background Device indications have changed for placement of continuous-flow left ventricular assist devices (CF-LVADs). We performed a multicenter analysis evaluating temporal variations in outcomes after CF-LVAD implantation. Methods & Results We retrospectively defined 3 time intervals to reflect changes in CF-LVAD technology (period 1, 2004–2009; period 2, 2010–2012; and period 3, 2012–2014). A total of 1,064 patients (Heartmate II [HMII] = 835; Heartware [HVAD] = 229) underwent CF-LVAD implantation from May 2004 to October 2014. Device utilization was different between periods: period 1: HMII = 134 (100%); period 2: HMII = 480 (88%) and HW = 63 (12%); and period 3: HMII = 221 (57%) and HW = 166 (43%); P <.001. Despite few baseline group differences, adjusted survivals were similar among the time periods (P =.96). Adjusted multivariable analysis revealed age (per 10-year increase) and Interagency Registry for Mechanically Assisted Circulatory Support category (1 vs all others) as the only independent predictors of mortality: P <.001 and P =.008, respectively. Furthermore, it also showed the later periods to be at an increased risk of adverse events: 1) pump thrombosis (periods 2 and 3); and 2) gastrointestinal bleeding (period 3). Conclusions Despite significant differences in device types, indications, and patient characteristics, post-implantation survivals were similar across time intervals. The most recent cohort seems to be at an increased risk of gastrointestinal bleeding and pump thrombosis.

Original languageEnglish (US)
Pages (from-to)852-858
Number of pages7
JournalJournal of Cardiac Failure
Volume23
Issue number12
DOIs
StatePublished - Dec 2017

Keywords

  • Ventricular assist devices
  • continuous-flow
  • outcomes
  • temporal analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Maltais, S., Anwer, L. A., Haglund, N. A., Cowger, J., Shah, P., Aaronson, K. D., Pagani, F. D., Dunlay, S. M., Singh, R., Salerno, C. T., & Stulak, J. M. (2017). Temporal Differences in Outcomes During Long-Term Mechanical Circulatory Support. Journal of Cardiac Failure, 23(12), 852-858. https://doi.org/10.1016/j.cardfail.2017.07.403