Continuous-Flow Left Ventricular Assist Device Support for Patients with Hypertrophic Cardiomyopathy: A Single Centre Experience

Purpose There is controversy over the use of durable left ventricular assist devices (LVADs) in supporting patients with hypertrophic cardiomyopathy (HCM) and advanced heart failure. HCM patients have smaller left ventricular (LV) dimensions and are at higher risk of LVAD inflow cannula occlusion from ventricular decompression. Right ventricular (RV) failure is also a concern in these patients. This study describes a single-centre experience of LVAD implantation in patients with heart failure due to HCM. Methods Cases were reviewed from a prospective registry of all LVAD implants at the University Health Network (Toronto, Canada) between 2006 and 2020 to identify patients with HCM. We determined baseline characteristics, peri-operative course and outcomes, including requirement for RV support, ICU and hospital length of stay and eventual outcome from LVAD support. Results We identified 15 patients with LVAD implantation for HCM with a history of heart failure of 6 (interquartile range: 4-12) years and peak VO2 of 9.6 (9.2-10.4) ml/kg/min. Median age was 57 (46-60) years, 1 (7%) patient was female (Table). During the index admission for LVAD implant, 5 (33%) patients required renal replacement therapy and 3 (20%) died due to ischemic bowel, tracheobronchitis and liver failure/sepsis, respectively. No patients required RV support. ICU stay was 8 (6-11) days and hospital stay 33 (16-65) days in those discharged from hospital. Overall, patients were supported for 5153 patient-days; 9 (60%) patients underwent heart transplant after LVAD support of 206 (110-458) days, 2 (13%) are currently supported and 1 died after 1671 days from presumed pump thrombosis. One patient required LVAD exchange for late pump thrombosis. Conclusion This single-centre experience demonstrated that LVAD support in patients with HCM is safe and effective as a bridge to transplant or destination therapy. Further work should explore patient characteristics favourable to LVAD therapy in HCM patients.