Koji Takeda1, Hiroo Takayama1, Bindu Kalesan2, Nir Uriel3, Paolo C Colombo3, Ulrich P Jorde3, Yoshifumi Naka4. 1. Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY. 2. Division of Surgery and Epidemiology, Department of Surgery, Columbia University Medical Center, New York, NY. 3. Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY. 4. Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY. Electronic address: yn33@cumc.columbia.edu.
Abstract
OBJECTIVES: Recent advances in technology and improved patient management have enabled the use of mechanical circulatory support for unexpected long-term periods. Improved long-term outcomes may facilitate the use of device therapy as an alternative to heart transplantation. However, there are scarce data about the long-term outcomes of continuous-flow left ventricular assist devices. This study sought to evaluate the long-term outcomes in patients receiving continuous-flow left ventricular assist devices. METHODS: Between March 2004 and June 2010, 140 patients underwent continuous-flow left ventricular assist device insertion as a bridge to transplantation or a destination therapy. These patients' charts were retrospectively reviewed. RESULTS: The initial strategy for continuous-flow left ventricular assist device therapy was bridge to transplantation in 115 patients (82%) and destination therapy in 25 patients (18%). Of those, 24 (17%) died on left ventricular assist device support, 94 (67%) were successfully bridged to transplantation, and 1 (0.71%) showed native heart recovery. Twenty-four patients (17%) had been on continuous-flow left ventricular assist device support for more than 3 years (mean, 3.9 years; range, 3.0-7.5 years). Estimated on-device survival at 1, 3, and 5 years was 83%, 75%, and 61%, respectively. Rehospitalizations due to bleeding, cardiac events, and device-related issues were common. The freedom from rehospitalization rates at 1 and 3 years was 31% and 6.9%, respectively. A total of 14 patients (10%) required device exchange. CONCLUSIONS: Current continuous-flow left ventricular assist devices can provide satisfactory long-term survival. However, rehospitalization is frequently required.
OBJECTIVES: Recent advances in technology and improved patient management have enabled the use of mechanical circulatory support for unexpected long-term periods. Improved long-term outcomes may facilitate the use of device therapy as an alternative to heart transplantation. However, there are scarce data about the long-term outcomes of continuous-flow left ventricular assist devices. This study sought to evaluate the long-term outcomes in patients receiving continuous-flow left ventricular assist devices. METHODS: Between March 2004 and June 2010, 140 patients underwent continuous-flow left ventricular assist device insertion as a bridge to transplantation or a destination therapy. These patients' charts were retrospectively reviewed. RESULTS: The initial strategy for continuous-flow left ventricular assist device therapy was bridge to transplantation in 115 patients (82%) and destination therapy in 25 patients (18%). Of those, 24 (17%) died on left ventricular assist device support, 94 (67%) were successfully bridged to transplantation, and 1 (0.71%) showed native heart recovery. Twenty-four patients (17%) had been on continuous-flow left ventricular assist device support for more than 3 years (mean, 3.9 years; range, 3.0-7.5 years). Estimated on-device survival at 1, 3, and 5 years was 83%, 75%, and 61%, respectively. Rehospitalizations due to bleeding, cardiac events, and device-related issues were common. The freedom from rehospitalization rates at 1 and 3 years was 31% and 6.9%, respectively. A total of 14 patients (10%) required device exchange. CONCLUSIONS: Current continuous-flow left ventricular assist devices can provide satisfactory long-term survival. However, rehospitalization is frequently required.
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