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Temporal Differences in Outcomes During Long-Term Mechanical Circulatory Support.

Abstract：

BACKGROUND:Device indications have changed for placement of continuous-flow left ventricular assist devices (CF-LVADs). We performed a multicenter analysis evaluating temporal variations in outcomes after CF-LVAD implantation. METHODS & RESULTS:We retrospectively defined 3 time intervals to reflect changes in CF-LVAD technology (period 1, 2004-2009; period 2, 2010-2012; and period 3, 2012-2014). A total of 1,064 patients (Heartmate II [HMII] = 835; Heartware [HVAD] = 229) underwent CF-LVAD implantation from May 2004 to October 2014. Device utilization was different between periods: period 1: HMII = 134 (100%); period 2: HMII = 480 (88%) and HW = 63 (12%); and period 3: HMII = 221 (57%) and HW = 166 (43%); P < .001. Despite few baseline group differences, adjusted survivals were similar among the time periods (P = .96). Adjusted multivariable analysis revealed age (per 10-year increase) and Interagency Registry for Mechanically Assisted Circulatory Support category (1 vs all others) as the only independent predictors of mortality: P < .001 and P = .008, respectively. Furthermore, it also showed the later periods to be at an increased risk of adverse events: 1) pump thrombosis (periods 2 and 3); and 2) gastrointestinal bleeding (period 3). CONCLUSIONS:Despite significant differences in device types, indications, and patient characteristics, post-implantation survivals were similar across time intervals. The most recent cohort seems to be at an increased risk of gastrointestinal bleeding and pump thrombosis.

journal_name

J Card Fail

journal_title

Journal of cardiac failure

authors

Maltais S,Anwer LA,Haglund NA,Cowger J,Shah P,Aaronson KD,Pagani FD,Dunlay SM,Singh R,Salerno CT,Stulak JM

doi

10.1016/j.cardfail.2017.07.403

subject

Has Abstract

pub_date

2017-12-01 00:00:00

pages

852-858

issue

12

eissn

1071-9164

issn

1532-8414

pii

S1071-9164(17)30622-X

journal_volume

23

pub_type

杂志文章,多中心研究

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