Outcomes on Continuous Flow Left Ventricular Assist Devices: A Single Institutional 9-Year Experience.

Background Continuous-flow left ventricular assist devices (LVADs) have become the standard of care for patients with advanced heart failure. The goal of this study was to review our 9-year institutional experience. Methods From March 2006 through May 2015, 231 patients underwent implantation of 240 CF LVADs, HeartMate II LVAD (Thoratec Corp., Pleasanton, CA; n = 205) or HVAD (HeartWare Inc., Framingham, MA; n = 35). Of these, 127 devices (52.9%) were implanted as bridge to transplantation (BTT) and 113 (47.1%) as destination therapy (DT). Results Mean age was 51.2 ± 11.9 years for BTT patients and 58.2 ± 11.4 years for DT patients ( p p p  = 0.038). Gastrointestinal bleeding was the most common complication (29.6%), followed by right ventricular failure (22.5%) and stroke (15.0%), with a similar incidence for BTT and DT patients. Preoperative liver biopsy (hazard ratio [HR] 2.27, p  = 0.036), mechanical support (HR 1.82, p  = 0.025), aspartate transaminase (HR 1.07, p  = 0.001), and alanine aminotransferase (HR 0.95, p  = 0.024) were severe independent predictors of survival in multivariate analysis. Conclusions These data indicate excellent survival for BTT and DT patients on long-term LVAD support. However, for LVAD therapy to become a plausible alternative to heart transplantation, we need to further decrease the incidence of postoperative complications.