Oscar Ö Braun1, Johan Nilsson2, Finn Gustafsson3, Göran Dellgren4, Arnt E Fiane5,6, Karl Lemström7, Laila Hubbert8, Laila Hellgren9, Lars H Lund10. 1. a Departments of Clinical Sciences, Cardiology , Lund University and Skåne University Hospital , Lund , Sweden. 2. b Departments of Clinical Sciences, Cardiothoracic Surgery , Lund University and Skåne University Hospital , Lund , Sweden. 3. c Department of Cardiology , Rigshospitalet , Copenhagen , Denmark. 4. d Department of Cardiothoracic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden. 5. e Department of Cardiothoracic Surgery , Oslo University Hospital , Oslo , Norway. 6. f Faculty of Medicine , University of Oslo , Oslo , Norway. 7. g Cardiothoracic Surgery, Heart and Lung Center , Helsinki University Hospital , Helsinki , Finland. 8. h Department of Medical and Health Sciences , Linköping University , Linköping , Sweden. 9. i Department of Cardiothoracic Surgery , Uppsala University Hospital , Uppsala , Sweden. 10. j Department of Medicine , Karolinska Institutet and Heart and Vascular Theme, Karolinska University Hospital , Stockholm , Sweden.
Abstract
OBJECTIVES: The purpose of this study was to assess complications and mortality and its predictors, with continuous-flow left ventricular assist devices (CF-LVADs) in the Nordic Countries. DESIGN: This was a retrospective, international, multicenter cohort study. RESULTS: Between 1993 and 2013, 442 surgically implanted long-term mechanical assist devices were used among 8 centers in the Nordic countries. Of those, 238 were CF-LVADs (HVAD or HeartMate II) implanted in patients >18 years with complete data. Postoperative complications and survival were compared and Cox proportion hazard regression analysis was used to identify predictors of mortality. The overall Kaplan-Meier survival rate was 75% at 1 year, 69% at 2 years and 63% at 3 years. A planned strategy of destination therapy had poorer survival compared to a strategy of bridge to transplantation or decision (2-year survival of 41% vs. 76%, p < .001). The most common complications were non-driveline infections (excluding sepsis) (44%), driveline infection (27%), need for continuous renal replacement therapy (25%) and right heart failure (24%). In a multivariate model age and left ventricular diastolic dimension was left as independent risk factors for mortality with a hazard ratio of 1.35 (95% confidence interval (CI) [1.01-1.80], p = .046) per 10 years and 0.88 (95% CI [0.72-0.99], p = .044) per 5 mm, respectively. CONCLUSION: Outcome with CF LVAD in the Nordic countries was comparable to other cohorts. Higher age and destination therapy require particularly stringent selection.
OBJECTIVES: The purpose of this study was to assess complications and mortality and its predictors, with continuous-flow left ventricular assist devices (CF-LVADs) in the Nordic Countries. DESIGN: This was a retrospective, international, multicenter cohort study. RESULTS: Between 1993 and 2013, 442 surgically implanted long-term mechanical assist devices were used among 8 centers in the Nordic countries. Of those, 238 were CF-LVADs (HVAD or HeartMate II) implanted in patients >18 years with complete data. Postoperative complications and survival were compared and Cox proportion hazard regression analysis was used to identify predictors of mortality. The overall Kaplan-Meier survival rate was 75% at 1 year, 69% at 2 years and 63% at 3 years. A planned strategy of destination therapy had poorer survival compared to a strategy of bridge to transplantation or decision (2-year survival of 41% vs. 76%, p < .001). The most common complications were non-driveline infections (excluding sepsis) (44%), driveline infection (27%), need for continuous renal replacement therapy (25%) and right heart failure (24%). In a multivariate model age and left ventricular diastolic dimension was left as independent risk factors for mortality with a hazard ratio of 1.35 (95% confidence interval (CI) [1.01-1.80], p = .046) per 10 years and 0.88 (95% CI [0.72-0.99], p = .044) per 5 mm, respectively. CONCLUSION: Outcome with CF LVAD in the Nordic countries was comparable to other cohorts. Higher age and destination therapy require particularly stringent selection.
Authors: Nicholas McNamara; Harry Narroway; Michael Williams; John Brookes; James Farag; David Cistulli; Paul Bannon; Silvana Marasco; Evgenij Potapov; Antonio Loforte Journal: Ann Cardiothorac Surg Date: 2021-03
Authors: Andreas Schaefer; Yvonne Schneeberger; Liesa Castro; Bjoern Sill; Yousuf Alassar; Meike Rybczynski; Markus J Barten; Hanno Grahn; Hermann Reichenspurner; Sebastian A Philipp; Alexander M Bernhardt Journal: Braz J Cardiovasc Surg Date: 2020-08-01