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

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)
JournalJournal of Cardiac Failure
DOIs
StateAccepted/In press - 2017

Fingerprint

Heart-Assist Devices
Equipment and Supplies
Thrombosis
Hemorrhage
Survival
Registries
Technology
Mortality

Keywords

  • Continuous-flow
  • Outcomes
  • Temporal analysis
  • Ventricular assist devices

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Maltais, S., Anwer, L. A., Haglund, N. A., Cowger, J., Shah, P., Aaronson, K. D., ... Stulak, J. M. (Accepted/In press). Temporal Differences in Outcomes During Long-Term Mechanical Circulatory Support. Journal of Cardiac Failure. https://doi.org/10.1016/j.cardfail.2017.07.403

Temporal Differences in Outcomes During Long-Term Mechanical Circulatory Support. / Maltais, Simon; Anwer, Lucman A.; Haglund, Nicholas A.; Cowger, Jennifer; Shah, Palak; Aaronson, Keith D.; Pagani, Francis D.; Dunlay, Shannon M; Singh, Ramesh; Salerno, Christopher T.; Stulak, John M.

In: Journal of Cardiac Failure, 2017.

Research output: Contribution to journalArticle

Maltais, S, Anwer, LA, Haglund, NA, Cowger, J, Shah, P, Aaronson, KD, Pagani, FD, Dunlay, SM, Singh, R, Salerno, CT & Stulak, JM 2017, 'Temporal Differences in Outcomes During Long-Term Mechanical Circulatory Support', Journal of Cardiac Failure. https://doi.org/10.1016/j.cardfail.2017.07.403
Maltais, Simon ; Anwer, Lucman A. ; Haglund, Nicholas A. ; Cowger, Jennifer ; Shah, Palak ; Aaronson, Keith D. ; Pagani, Francis D. ; Dunlay, Shannon M ; Singh, Ramesh ; Salerno, Christopher T. ; Stulak, John M. / Temporal Differences in Outcomes During Long-Term Mechanical Circulatory Support. In: Journal of Cardiac Failure. 2017.
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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.",
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AU - Anwer, Lucman A.

AU - Haglund, Nicholas A.

AU - Cowger, Jennifer

AU - Shah, Palak

AU - Aaronson, Keith D.

AU - Pagani, Francis D.

AU - Dunlay, Shannon M

AU - Singh, Ramesh

AU - Salerno, Christopher T.

AU - Stulak, John M.

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N2 - 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.

AB - 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.

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KW - Temporal analysis

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