Single-centre experience of 85 patients with a continuous-flow left ventricular assist device: clinical practice and outcome after extended support

• Published in: European journal of cardio-thoracic surgery Vol. 44; no. 3; pp. e233 - e238
• Main Authors: Lok, Sjoukje I., Martina, Jerson R., Hesselink, Tim, Rodermans, Ben F.M., Hulstein, Nelienke, Winkens, Bjorn, Klöpping, Corinne, Kirkels, J. Hans, Doevendans, Pieter A., Ramjankhan, Faiz, de Weger, Roel A., de Jonge, Nicolaas, Lahpor, Jaap R.
• Format: Journal Article
• Language: English
• Published: Germany Oxford University Press 01.09.2013
• Subjects: Adolescent; Adult; Aged; Echocardiography; Female; Heart Failure - diagnostic imaging; Heart Failure - surgery; Heart-Assist Devices - adverse effects; Heart-Assist Devices - statistics & numerical data; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Postoperative Complications - etiology; Treatment Outcome; HeartMate II; Adverse events; Survival; Continuous-flow LVAD
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezt347

OBJECTIVES We evaluated our single-centre clinical experience with the HeartMate II (HM II) left ventricular assist device (LVAD) as a bridge to transplantation (BTT) in end-stage heart failure (HF) patients. METHODS Survival rates, echocardiographic parameters, laboratory values and adverse events of 85 consecutive patients supported with a HM II were evaluated. RESULTS Overall, mean age was 45 ± 13 years, 62 (73%) were male and non-ischaemic dilatated cardiomyopathy was present in 60 (71%) patients. The median duration of mechanical support was 387 days (IQR 150-600), with a range of 1-1835 days. The 6-month, 1-, 2-, 3- and 4-year survival rates during HM II LVAD support were 85, 81, 76, 76 and 68%, respectively. Echocardiographic parameters demonstrated effective left ventricular unloading, while laboratory results reflected adequate organ perfusion. However, HM II support was associated with adverse events, such as infections in 42 patients (49%; 0.67 events/patient-year), cardiac arrhythmia in 44 (52%; 0.86 events/patient-year), bleeding complications in 32 (38%; 0.43 events/patient-year) and neurological dysfunction in 17 (20%; 0.19 events/patient-year). CONCLUSIONS In view of the increasing shortage of donor hearts, HM II LVAD support may be considered a life-saving treatment in end-stage HF patients, with good survival. However, it is still associated with some serious adverse events, of which neurological complications are the most critical.