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 three time intervals to reflect changes in CF-LVAD technology (Period 1: 2004 to 2009; Period 2: 2010 to 2012; and Period 3: 2012 to 2014). A total of 1,064 patients (HeartMate II (HMII)=835, HeartWare (HVAD)=229) underwent CF-LVAD implantation between May 2004 and October 2014. Device utilization was different between periods; Period 1: HMII=134(100%), Period 2: HMII=480(88%) vs.HW=63(12%), and Period 3: HMII=221(57%) vs HW=166(43%), p<0.001. Despite few baseline group differences, adjusted survival was comparable between time periods (p=0.96). Adjusted multivariable analysis revealed age (per 10 years increase) and INTERMACS category (1 vs. all others) as the only independent predictors of mortality, p<0.001 and p=0.008, respectively. Furthermore, it also showed the later periods to be at an increased risk of adverse events: 1) pump thrombus (period 2 and 3), and 2) gastrointestinal bleeding (period 3).
Despite significant differences in device types, indications, and patient characteristics, post-implant survival is comparable across time intervals. Most recent cohort seems to be at an increased risk of gastrointestinal bleeding and pump thrombus.