An Analysis of Our Ten-Year Cohort of Patients with Cardiac Amyloidosis Supported by the Continuous-Flow Left Ventricular Assist Device

Purpose Limited data exists on the use continuous-flow left ventricular assist device (CF-LVAD) in patients with cardiac amyloidosis (CA). The largest single center analysis on CF-LVAD support in patients with CA reports a 50% mortality at 6-months. Our primary aim was to examine the survival and morbidity of our patients with diagnosed CA and supported by CF-LVAD. Methods Data on demographics, type of cardiac amyloidosis, pre-implant echocardiographic features, and post-implant survival and morbidity outcomes was retrospectively extracted on patients with CA and supported by CF-LVAD at our institution from January 2009-October 2019. Descriptive statistics are reported. Results Six patients with diagnosed CA (mean age 64 ± 9 years) were supported by CF-LVAD (3 centrifugal, 3 axial) for a median 32.3 months (range 8.4, 48.3). Table 1 depicts pertinent patient demographics, survival and morbidity. Four patients had ATTR amyloid, and 2 had AL amyloidosis. LV ejection fraction (10-45%) and end-diastolic dimension (4.4-6.0 cm) varied pre-implant. All 6 patients were alive at 6-months on CF-LVAD support. Overall, 2 patients died, 2 were bridged to heart transplant, and 2 remain on destination therapy. One patient required a right ventricular assist device and dialysis immediately post-implant, and two patients had hospital re-admission for right heart failure. Various etiologies contributed to re-hospitalizations post-implant (data not shown). With CF-LVAD support, the patients with AL amyloid survived for a median 47.8 months. Conclusion Our limited experience in patients with cardiac amyloidosis highlights the feasibility of supporting these patients with CF-LVAD as bridge to transplant or destination therapy. Future analyses are warranted to refine careful patient selection to improve outcomes, with particular consideration to the interplay between right ventricular hemodynamics and renal function.