Long-term survival on LVAD support: Device complications and end-organ dysfunction limit long-term success

Imad M. Hariri, Todd Dardas, Manreet Kanwar, Rebecca Cogswell, Igor Gosev, Ezequiel Molina, Susan L. Myers, James K. Kirklin, Palak Shah, Francis D. Pagani, Jennifer A. Cowger

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

BACKGROUND: Preoperative variables can predict short term left ventricular assist device (LVAD) survival, but predictors of extended survival remain insufficiently characterized.

METHOD: Patients undergoing LVAD implant (2012-2018) in the Intermacs registry were grouped according to time on support: short-term (<1 year, n = 7,483), mid-term (MT, 1-3 years, n = 5,976) and long-term (LT, ≥3 years, n = 3,015). Landmarked hazard analyses (adjusted hazard ratio, HR) were performed to identify correlates of survival after 1 and 3 years of support.

RESULTS: After surviving 1 year of support, additional LVAD survival was less likely in older (HR 1.15 per decade), Caucasian (HR 1.22) and unmarried (HR 1.16) patients (p < 0.05). After 3 years of support, only 3 preoperative characteristics (age, race, and history of bypass surgery, p < 0.05) correlated with extended survival. Postoperative events most negatively influenced achieving LT survival. In those alive at 1 year or 3 years, the occurrence of postoperative renal (creatinine HR MT = 1.09; LT HR = 1.10 per mg/dl) and hepatic dysfunction (AST HR MT = 1.29; LT HR = 1.34 per 100 IU), stroke (MT HR = 1.24; LT HR = 1.42), infection (MT HR = 1.13; LT HR = 1.10), and/or device malfunction (MT HR = 1.22; LT HR = 1.46) reduced extended survival (all p ≤ 0.03).

CONCLUSIONS: Success with LVAD therapy hinges on achieving long term survival in more recipients. After 1 year, extended survival is heavily constrained by the occurrence of adverse events and postoperative end-organ dysfunction. The growth of destination therapy intent mandates that future LVAD studies be designed with follow up sufficient for capturing outcomes beyond 24 months.

Original languageEnglish (US)
Pages (from-to)161-170
Number of pages10
JournalJournal of Heart and Lung Transplantation
Volume41
Issue number2
Early online dateJul 24 2021
DOIs
StatePublished - Feb 2022

Bibliographical note

Publisher Copyright:
© 2021 International Society for Heart and Lung Transplantation

Keywords

  • LVAD
  • complications
  • risk factors
  • survival

PubMed: MeSH publication types

  • Journal Article
  • Multicenter Study
  • Research Support, N.I.H., Extramural

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