Short and long-term outcomes of continuous-flow left ventricular assist device therapy in 79 patients with end-stage heart failure.

INTRODUCTION: Increasing numbers of patients (pts) with end-stage heart failure (ESHF) and shortage of heart donors impose use of mechanical circulatory support. OBJECTIVES: The aim of this single-center retrospective study was to evaluate short and long-term outcomes of continuous-flow left ventricular assist device (CF-LVAD) therapy in ESHF pts. PATIENTS AND METHODS: Data of 79 pts (77 male, 2 female, mean age - 50.3 years, mean INTERMACS profile-3.1) implanted with CF-LVAD in years 2009-2017 were collected and analyzed. In 19 pts (24%) HeartMate3 was implanted, 9 (11.4%) had HeartMate2 and 51 (64.6 %) had HeartWare implanted. RESULTS: Mean time on CF-LVAD support was 605 days (1-1834). There were 2 device exchanges due to pump thrombosis (PT) and 1 explantation due to heart regeneration, 9 pts (11.4%) underwent heart transplantation. Among adverse events (AE), strokes (48% - non-disabling) were present in 27.8% of pts (9 - ischemic, 14 - hemorrhagic stroke, 1 patient had both) and occurred despite standardized anticoagulation regimen. Major gastrointestinal bleeding and PT both occurred in 13 pts (16.4%); 18 pts (22.8%) developed driveline infections (15 pts - 19.0% recurrent). Hemorrhagic stroke and bacteremia had a negative impact on survival. Hemorrhagic stroke prevailed as a cause of death. Survival probability was 0.9.at 1 month and 0.8, 0.69, 0.58 and 0.46 at 1, 2, 3 and 4 years respectively. CONCLUSIONS: Although AE during CF-LVAD support remain substantial, they do not have a significant impact on mortality except for hemorrhagic stroke and bacteremia. Novel devices seem to challenge these shortcomings, but larger studies are needed to support this thesis.