Cardiology Letters 2020, 29(1):50-56

Long-term left ventricular assist devices in the treatment of heart failure in Slovakia

Lesný P¹, Hulman M², Olejárová I³, Hudec V², Gašparovič I², Šramatý R³, Luknár M¹, Gonçalvesová E¹

¹ Kardiologická klinika Lekárská fakulta Univerzita Komenského a Národného ústav srdcových a cievnych chorôb, a. s., Bratislava

² Klinika kardiochirurgie Lekárská fakulta Univerzita Komenského a Národný ústav srdcových a cievnych chorôb, a. s., Bratislava

³ Oddelene anesteziológie a intenzívnej medicíny, Národný ústav srdcových a cievnych chorôb, a. s., Bratislava, Slovenská republika

Aim: To evaluate survival and to analyse causes of mortality and morbidity in patients after left ventricular assist device (LVAD) implantation. To conceive our current strategy of LVAD use in the treatment of heart failure (HF).

Patients and methods: One hundred and twenty-seven patients (88% men) were analysed. Mean age was 49.6 ± 11.7 years. All patients were in NYHA class IV, left ventricular ejection fraction was 18.4 ± 5.4%, and cardiac index 1.8 ± 0.5 L/min/m2. At the time of implant, 74% of patients were inotrope-dependent (Intermacs profile 1-3), 15% of patients were in cardiogenic shock (Intermacs 1). LVAD implant strategy was bridge to transplant in 53%, bridge to decision in 42%, and destination therapy in 5% of patients.

Results: Mean duration on LVAD was 426 days. Twelve months after implantation, 57% of patients were alive on LVAD, 17% underwent heart transplant, and 26% of patients died. Two years after implantation 40% of patients were alive on LVAD, 31% underwent heart transplant, and 29% of patients died. The most frequent cause of hospital mortality was bleeding (46%). Pump thrombosis and multi-organ failure were the most frequent causes of long-term mortality (23% each). Driveline infections were the dominant reason for rehospitalisation (27%).

Conclusions: Due to long-term experience with LVAD implantation with favourable results and a lower activity in our transplant programme, we prefer an early LVAD implant to an uncertain, and presumably long, waiting period for an appropriate donor in the case of haemodynamic instability of a transplant candidate. In the assessment of transplant urgency, patients with similar circulatory status who cannot receive an LVAD are prioritized over those with an implanted LVAD. Fig. 3, Tab. 3, Ref. 19, on-line full text (Free, PDF) www. cardiologyletters.sk

Keywords: advanced heart failure; left ventricular assist device; survival; bridge to transplant

Published: January 1, 2020  Show citation