BACKGROUND: Use of wearable left ventricular assist systems (LVAS) in the treatment of advanced heart failure has steadily increased since 1993, when these devices became generally available in Europe. The aim of this study was to identify in an unselected cohort of LVAS recipients those aspects of patient selection that have an impact on postimplant survival. METHODS AND RESULTS: Data were obtained from the Novacor European Registry. Between 1993 and 1999, 464 patients were implanted with the Novacor LVAS. The majority had idiopathic (60%) or ischemic (27%) cardiomyopathy; the median age at implant was 49 (16 to 75) years. The median support time was 100 days (4.1 years maximum). Forty-nine percent of the recipients were discharged from the hospital on LVAS; they spent 75% of their time out of the hospital. For a subset of 366 recipients, for whom a complete set of data was available, multivariate analysis revealed that the following preimplant conditions were independent risk factors for survival after LVAS implantation: respiratory failure associated with septicemia (odds ratio 11.2), right heart failure (odds ratio 3.2), age >65 years (odds ratio 3.01), acute postcardiotomy (odds ratio 1.8), and acute infarction (odds ratio 1.7). For patients without any of these factors, the 1-year survival after LVAS implantation including the posttransplantation period was 60%; for the combined group with at least 1 risk factor, it was 24%. CONCLUSIONS: Careful selection, specifically implantation before patients become moribund, and improvement of management may result in improved outcomes of LVAS treatment for advanced heart failure.
BACKGROUND: Use of wearable left ventricular assist systems (LVAS) in the treatment of advanced heart failure has steadily increased since 1993, when these devices became generally available in Europe. The aim of this study was to identify in an unselected cohort of LVAS recipients those aspects of patient selection that have an impact on postimplant survival. METHODS AND RESULTS: Data were obtained from the Novacor European Registry. Between 1993 and 1999, 464 patients were implanted with the Novacor LVAS. The majority had idiopathic (60%) or ischemic (27%) cardiomyopathy; the median age at implant was 49 (16 to 75) years. The median support time was 100 days (4.1 years maximum). Forty-nine percent of the recipients were discharged from the hospital on LVAS; they spent 75% of their time out of the hospital. For a subset of 366 recipients, for whom a complete set of data was available, multivariate analysis revealed that the following preimplant conditions were independent risk factors for survival after LVAS implantation: respiratory failure associated with septicemia (odds ratio 11.2), right heart failure (odds ratio 3.2), age >65 years (odds ratio 3.01), acute postcardiotomy (odds ratio 1.8), and acute infarction (odds ratio 1.7). For patients without any of these factors, the 1-year survival after LVAS implantation including the posttransplantation period was 60%; for the combined group with at least 1 risk factor, it was 24%. CONCLUSIONS: Careful selection, specifically implantation before patients become moribund, and improvement of management may result in improved outcomes of LVAS treatment for advanced heart failure.
Authors: Elizabeth A Genovese; Mary Amanda Dew; Jeffrey J Teuteberg; Marc A Simon; Jay K Bhama; Christian A Bermudez; Kathleen L Lockard; Steve Winowich; Robert L Kormos Journal: J Heart Lung Transplant Date: 2010-07-01 Impact factor: 10.247
Authors: Felix Hennig; Alexander V Stepanenko; Hans B Lehmkuhl; Marian Kukucka; Michael Dandel; Thomas Krabatsch; Roland Hetzer; Evgenij V Potapov Journal: Gen Thorac Cardiovasc Surg Date: 2011-01-12
Authors: Rachel J Gordon; Alan D Weinberg; Francis D Pagani; Mark S Slaughter; Pat S Pappas; Yoshifumi Naka; Daniel J Goldstein; Walter P Dembitsky; Julie C Giacalone; Jennifer Ferrante; Deborah D Ascheim; Alan J Moskowitz; Eric A Rose; Annetine C Gelijns; Franklin D Lowy Journal: Circulation Date: 2013-01-11 Impact factor: 29.690
Authors: Mehmet C Oz; Annetine C Gelijns; Leslie Miller; Cuiling Wang; Patrice Nickens; Raymond Arons; Keith Aaronson; Wayne Richenbacher; Clifford van Meter; Karl Nelson; Alan Weinberg; John Watson; Eric A Rose; Alan J Moskowitz Journal: Ann Surg Date: 2003-10 Impact factor: 12.969