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

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)
JournalJournal of Heart and Lung Transplantation
Early online dateJul 24 2021
DOIs
StateE-pub ahead of print - Jul 24 2021

Bibliographical note

Funding Information:
Financial support: Intermacs data prior to 2018 was supported by NHLBI grant HHSN2682011000250. Drs. Cowger, Cogswell, and Molina, Shah, and Gosev are consultants and/or speakers for Abbott, Inc and their institutions receive clinical trial funds. Dr. Cogswell is an advisor for Medtronic and her husband is a Medtronic employee. Dr. Kanwar is on the Abiomed advisory board. Dr. Cowger is also on the advisory board and/or steering committee for Medtronic (for HVAD), Procyrion and Cordella-Endotronix and her institution receives clinical trial funds from Medtronic. Dr. Shah also receives funds from Medtronic, Merck, Bayer, NuPulse, and Ortho Clinical Diagnostics. He receives support from NIH K23- 1K23HL143179-01A1. Dr. Pagani is on the scientific advisory board for FineHeart and has an institutional contract for research with Abbott. Dr. Kirklin and Susan Myers receive partial salary support from the STS in their role in the DCC. Drs. Hariri and Dardas have no conflicts of interest to report.

Funding Information:
Shah: Merck, Bayer, Abbott, Medtronic, AHA / Enduring Hearts (grant support), Procyrion, NuPulseCV, Ortho Clinical Diagnostics (consultant); Dr. Shah is supported under NIH K23- 1K23HL143179-01A1

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

Keywords

  • LVAD
  • complications
  • risk factors
  • survival

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